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General NPI Number Information
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NPI Number | 1609035450
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Entity Type | Individual
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Provider Name | BRADLEY EDWARD PUTVIN PT
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Gender | Male
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Dates
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Enumeration Date | 06/06/2008
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Last Update Date | 01/06/2009
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Provider Practice Location Address
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Address Line | 5889 WHITMORE LAKE RD SUITE C
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City | BRIGHTON
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State | MI
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Zip | 48116-1998
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Country | US
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Telephone | 810-229-7931
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Fax | 810-229-7935
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Provider Business Mailing Address
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Address Line | 27733 SCHOENHERR RD
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City | WARREN
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State | MI
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Zip | 48088-6641
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Country | US
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Telephone | 810-923-2361
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Fax | 586-427-6642
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501001469
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License Number State | MI
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