Provider Demographics
NPI:1023021490
Name:BRADLEY, RODNEY CLARKE (MS, PT)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:CLARKE
Last Name:BRADLEY
Suffix:
Gender:M
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2336 HORSLEY DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-6965
Mailing Address - Country:US
Mailing Address - Phone:804-360-1506
Mailing Address - Fax:
Practice Address - Street 1:9101 MIDLOTHIAN TPKE
Practice Address - Street 2:SUITE 200
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-5022
Practice Address - Country:US
Practice Address - Phone:804-272-9192
Practice Address - Fax:804-272-9257
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305003650225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist