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General NPI Number Information
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NPI Number | 1598265530
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Entity Type | Individual
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Provider Name | BRADLEY THOMAS HOESMAN PTA
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Gender | Male
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Dates
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Enumeration Date | 02/16/2018
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Last Update Date | 02/16/2018
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Provider Practice Location Address
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Address Line | 8290 W C AVE
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City | KALAMAZOO
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State | MI
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Zip | 49009-8825
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Country | US
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Telephone | 269-343-2587
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Fax |
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Provider Business Mailing Address
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Address Line | 6741 TALL OAKS DR APT 2A
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City | KALAMAZOO
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State | MI
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Zip | 49009-7252
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Country | US
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Telephone | 269-375-4366
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 5502000095
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License Number State | MI
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