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General NPI Number Information
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NPI Number | 1952687493
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Entity Type | Individual
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Provider Name | BRADLEY LAWRENCE TREADWAY ATC
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Gender | Male
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Dates
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Enumeration Date | 10/28/2011
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Last Update Date | 10/28/2011
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Provider Practice Location Address
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Address Line | 400 MONTGOMERY AVE
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City | WEST CHESTER
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State | PA
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Zip | 19380-4456
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Country | US
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Telephone | 484-266-3439
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Fax |
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Provider Business Mailing Address
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Address Line | 812 GOSHEN RD APT. F28
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City | WEST CHESTER
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State | PA
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Zip | 19380-4360
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Country | US
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Telephone | 484-678-1990
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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 | RT003986
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License Number State | PA
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