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General NPI Number Information
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NPI Number | 1295780872
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Entity Type | Individual
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Provider Name | BRADLEY R HAMMERSLEY
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Gender | Male
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Dates
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Enumeration Date | 05/23/2006
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Last Update Date | 02/21/2011
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Provider Practice Location Address
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Address Line | 632 W MAIN ST
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City | PERU
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State | IN
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Zip | 46970-1747
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Country | US
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Telephone | 765-473-4220
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Fax | 765-473-4223
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Provider Business Mailing Address
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Address Line | 632 W MAIN ST
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City | PERU
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State | IN
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Zip | 46970-1747
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Country | US
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Telephone | 765-473-4220
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Fax | 765-473-4223
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 07000906
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 07000906
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License Number State | IN
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