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NPI Code Detail

MEDICARE: DAVID ANTHONY BRADLEY RBT

MEDICARE: DAVID ANTHONY BRADLEY RBT
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1457150161
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID ANTHONY BRADLEY RBT
Provider Business Mailing Address
First Line : 750 LINCOLN WAY E
Second Line :
City : SOUTH BEND
State : IN
Zip : 46601-3250
Country : US
Telephone Number : 574-786-0088
Fax Number : 574-366-0080
Provider Business Practice Location Address
First Line : 750 LINCOLN WAY E
Second Line :
City : SOUTH BEND
State : IN
Zip : 46601-3250
Country : US
Telephone Number : 574-786-0088
Fax Number : 574-366-0080
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/13/2025
Last Update Date : 03/13/2025

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Directions to “ DAVID ANTHONY BRADLEY RBT” Practice Location

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