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General NPI Number Information
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NPI Number | 1164085544
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Entity Type | Individual
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Provider Name | ROBERT BRADLEY LAC, LMBT
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Gender | Male
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Dates
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Enumeration Date | 04/21/2019
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Last Update Date | 04/21/2019
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Provider Practice Location Address
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Address Line | 3405 LEWISTON RD STE E
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City | GREENSBORO
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State | NC
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Zip | 27410-9827
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Country | US
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Telephone | 910-813-6425
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Fax |
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Provider Business Mailing Address
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Address Line | 4425 BAYLOR ST STE E
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City | GREENSBORO
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State | NC
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Zip | 27455-2565
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Country | US
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Telephone | 910-813-6425
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 1016
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License Number State | NC
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