MEDICARE: MS. PAIGE W BRADLEY MS/PT

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	2251P0200X	Pediatric Physical Therapist	005142	KY
2	225100000X	Physical Therapist

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
2	000000783289	OTHER	KY	ANTHEM PIN

General Provider Information

NPI Number	:	1518140250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PAIGE W BRADLEY MS/PT

Provider Business Mailing Address
First Line	:	314 HIGHLAND PARK DR
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-3487
Country	:	US
Telephone Number	:	859-353-5022
Fax Number	:	859-353-5047

Provider Business Practice Location Address
First Line	:	314 HIGHLAND PARK DR
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-3487
Country	:	US
Telephone Number	:	859-353-5022
Fax Number	:	859-353-5047

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

Provider Enumeration Date	:	12/17/2007
Last Update Date	:	12/22/2014

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