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NPI Code Detail

MEDICARE: MR. BRADLEY PHILLIP HARDESTY MPT

MEDICARE: MR. BRADLEY PHILLIP HARDESTY MPT
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
1225100000XPhysical Therapist1175SD
2225100000XPhysical Therapist1141208TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14996113OTHERSDBLUE CROSS BLUE SHIELD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1649209149
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BRADLEY PHILLIP HARDESTY MPT
Provider Business Mailing Address
First Line : 8306 SATURN PL
Second Line :
City : EL PASO
State : TX
Zip : 79904-2525
Country : US
Telephone Number : 605-431-0709
Fax Number :
Provider Business Practice Location Address
First Line : 3650 MANSELL RD STE 300
Second Line :
City : ALPHARETTA
State : GA
Zip : 30022-3068
Country : US
Telephone Number : 877-896-3660
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2006
Last Update Date : 09/11/2025

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