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General NPI Number Information
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NPI Number | 1710381017
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Entity Type | Organization
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Legal Business Name | MARLENE BRADNOCK
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Dates
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Enumeration Date | 10/15/2014
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Last Update Date | 10/15/2014
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Provider Practice Location Address
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Address Line | 178-18 120 AVE
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City | JAMAICA
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State | NY
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Zip | 11434
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Country | US
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Telephone | 347-357-7881
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Fax |
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Provider Business Mailing Address
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Address Line | 17818 120TH AVE
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City | JAMAICA
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State | NY
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Zip | 11434-2716
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Country | US
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Telephone | 347-357-7881
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST ASSISTANT
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Name | MS. MARLENE A BRADNOCK
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Credential | PTA
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Telephone | 347-357-7881
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 002442
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License Number State | NY
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