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NPI Code Detail

MEDICARE: BRAD E POWELL DPT

MEDICARE: BRAD E POWELL DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist1324550TX
2225100000XPhysical Therapist070-021942IL

General Provider Information

NPI Number : 1023483864
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRAD E POWELL DPT
Provider Business Mailing Address
First Line : 2122 YORK RD STE 300
Second Line :
City : OAK BROOK
State : IL
Zip : 60523-1925
Country : US
Telephone Number : 630-575-6200
Fax Number :
Provider Business Practice Location Address
First Line : 6860 N FRONTAGE RD STE B
Second Line :
City : BURR RIDGE
State : IL
Zip : 60527-7828
Country : US
Telephone Number : 630-686-4123
Fax Number : 630-581-0385
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/04/2015
Last Update Date : 04/19/2023

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