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General NPI Number Information
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NPI Number | 1548614381
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Entity Type | Organization
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Legal Business Name | BRADBURY EARLY INTERVENTION, PLLC
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Dates
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Enumeration Date | 04/18/2016
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Last Update Date | 04/18/2016
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Provider Practice Location Address
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Address Line | 1636 DEER LN APT 3
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City | LOUISVILLE
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State | KY
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Zip | 40205-1269
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Country | US
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Telephone | 270-307-6399
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Fax |
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Provider Business Mailing Address
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Address Line | 1636 DEER LN APT 3
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City | LOUISVILLE
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State | KY
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Zip | 40205-1269
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Country | US
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Telephone | 270-307-6399
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MARTI BRADBURY
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Credential | PT, DPT
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Telephone | 270-307-6399
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 006170
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License Number State | KY
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