MEDICARE: BRADLEY PHYSIOTHERAPY PC

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	2251X0800X	Orthopedic Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CP261	OTHER	CA	IRS

General Provider Information

NPI Number	:	1104472752
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRADLEY PHYSIOTHERAPY PC

Provider Business Mailing Address
First Line	:	19732 MACARTHUR BLVD STE 125
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92612-2455
Country	:	US
Telephone Number	:	949-644-2022
Fax Number	:	949-644-1914

Provider Business Practice Location Address
First Line	:	19732 MACARTHUR BLVD STE 125
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92612-2455
Country	:	US
Telephone Number	:	949-644-2022
Fax Number	:	949-644-1914

Authorized Official
Title or Position	:	OWNER
Name	:	KATHY BRADLEY
Credential	:	DPT
Telephone Number	:	949-644-2022

Provider Enumeration Date	:	08/09/2019
Last Update Date	:	12/18/2020

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