MEDICARE: SUSAN BRADLEY 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
1	225100000X	Physical Therapist	16370	MA
2	2251X0800X	Orthopedic Physical Therapist	16370	MA

General Provider Information

NPI Number	:	1083791743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN BRADLEY DPT

Provider Business Mailing Address
First Line	:	108 MADISON AVE
Second Line	:
City	:	NEWTONVILLE
State	:	MA
Zip	:	02460-1949
Country	:	US
Telephone Number	:	617-256-6205
Fax Number	:

Provider Business Practice Location Address
First Line	:	108 MADISON AVE
Second Line	:
City	:	NEWTONVILLE
State	:	MA
Zip	:	02460-1949
Country	:	US
Telephone Number	:	617-256-6205
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	09/24/2021

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Directions to “ SUSAN BRADLEY DPT” Practice Location

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