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General NPI Number Information
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NPI Number | 1790677078
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Entity Type | Individual
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Provider Name | ERICA BRADLEY PTA
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Gender | Female
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Dates
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Enumeration Date | 07/19/2025
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Last Update Date | 07/19/2025
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Provider Practice Location Address
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Address Line | 31 SCHOOL DR
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City | MELBOURNE
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State | AR
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Zip | 72556-8620
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Country | US
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Telephone | 870-916-2269
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Fax |
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Provider Business Mailing Address
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Address Line | 6673 E AR 58 HWY
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City | SIDNEY
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State | AR
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Zip | 72577-9179
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Country | US
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Telephone | 870-509-0828
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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 | 5031
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License Number State | AR
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