MEDICARE: BRADSKY THERAPY AND MOBILITY, LLC

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

General Provider Information

NPI Number	:	1871361071
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRADSKY THERAPY AND MOBILITY, LLC

Provider Business Mailing Address
First Line	:	2089 HIDDEN VALLEY DR
Second Line	:
City	:	CROWN POINT
State	:	IN
Zip	:	46307-9331
Country	:	US
Telephone Number	:	219-796-6622
Fax Number	:

Provider Business Practice Location Address
First Line	:	2089 HIDDEN VALLEY DR
Second Line	:
City	:	CROWN POINT
State	:	IN
Zip	:	46307-9331
Country	:	US
Telephone Number	:	219-796-6622
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	DR. JENNIFER LEIGH BRADSKY
Credential	:	DPT
Telephone Number	:	219-796-6622

Provider Enumeration Date	:	12/18/2023
Last Update Date	:	12/18/2023

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