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General NPI Number Information
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NPI Number | 1760848402
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Entity Type | Individual
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Provider Name | BRADLEY SKENDZEL ATC
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Gender | Male
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Dates
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Enumeration Date | 01/11/2016
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Last Update Date | 01/11/2016
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Provider Practice Location Address
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Address Line | 100 S BRAINARD AVE
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City | LA GRANGE
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State | IL
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Zip | 60525-2101
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Country | US
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Telephone | 708-579-6300
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Fax |
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Provider Business Mailing Address
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Address Line | 361 WHEELER DR
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City | LEMONT
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State | IL
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Zip | 60439-6147
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Country | US
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Telephone | 708-522-3752
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 096002889
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License Number State | IL
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