MEDICARE: DR. KIRK THOMAS BRADLEY PT,DPT, M.S., ATC

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	PT 23700	CA
2	2251E1200X	Ergonomics Physical Therapist	PT 23700	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205926938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIRK THOMAS BRADLEY PT,DPT, M.S., ATC

Provider Business Mailing Address
First Line	:	13976 E SPARROW HAWK DR
Second Line	:
City	:	LOCKEFORD
State	:	CA
Zip	:	95237-9545
Country	:	US
Telephone Number	:	209-727-5594
Fax Number	:

Provider Business Practice Location Address
First Line	:	2105 W MARCH LN STE 3
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95207-6407
Country	:	US
Telephone Number	:	209-951-3265
Fax Number	:	209-351-3285

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

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	09/11/2025

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Directions to “ DR. KIRK THOMAS BRADLEY PT,DPT, M.S., ATC” Practice Location

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