MEDICARE: BRADLEY JAMES MILES MS, 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	261QP2000X	Physical Therapy Clinic/Center	AT000385	GA

General Provider Information

NPI Number	:	1760783021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRADLEY JAMES MILES MS, ATC

Provider Business Mailing Address
First Line	:	3051 WATSON BLVD STE 400
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31093-8556
Country	:	US
Telephone Number	:	478-953-7556
Fax Number	:

Provider Business Practice Location Address
First Line	:	3051 WATSON BLVD STE 400
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31093-8556
Country	:	US
Telephone Number	:	478-953-7556
Fax Number	:

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

Provider Enumeration Date	:	11/03/2010
Last Update Date	:	11/03/2010

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