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NPI Code Detail

MEDICARE: CAROL BRADLEY

MEDICARE: CAROL BRADLEY
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
1225400000XRehabilitation Practitioner

General Provider Information

NPI Number : 1538386362
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAROL BRADLEY
Provider Business Mailing Address
First Line : 2592 MADISON AVE
Second Line :
City : ALTADENA
State : CA
Zip : 91001-2324
Country : US
Telephone Number : 626-395-7100
Fax Number :
Provider Business Practice Location Address
First Line : 12450 VAN NUYS BLVD STE 100
Second Line :
City : PACOIMA
State : CA
Zip : 91331-1392
Country : US
Telephone Number : 626-395-7100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2007
Last Update Date : 07/08/2007

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Directions to “ CAROL BRADLEY ” Practice Location

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