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General NPI Number Information
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NPI Number | 1902762883
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Entity Type | Individual
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Provider Name | ERNESTINE MARIE BRADLEY LMT
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Gender | Female
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Dates
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Enumeration Date | 01/05/2026
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Last Update Date | 01/05/2026
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Provider Practice Location Address
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Address Line | 1602 S BURNSIDE AVE STE C
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City | GONZALES
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State | LA
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Zip | 70737-4400
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Country | US
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Telephone | 225-623-1780
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Fax |
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Provider Business Mailing Address
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Address Line | 445 W 13TH ST
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City | VACHERIE
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State | LA
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Zip | 70090-5223
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Country | US
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Telephone | 225-623-1780
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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 | 172M00000X
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Taxonomy Name | Mechanotherapist
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License Number | LA7981
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License Number State | LA
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