Provider Demographics
NPI:1073709978
Name:COOPER, BRADLEY DONALD (PT, DPT, OCS, CSCS)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:DONALD
Last Name:COOPER
Suffix:
Gender:M
Credentials:PT, DPT, OCS, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 N 9TH ST
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:NE
Mailing Address - Zip Code:68370-1403
Mailing Address - Country:US
Mailing Address - Phone:402-768-2575
Mailing Address - Fax:
Practice Address - Street 1:535 N 9TH ST
Practice Address - Street 2:
Practice Address - City:HEBRON
Practice Address - State:NE
Practice Address - Zip Code:68370-1403
Practice Address - Country:US
Practice Address - Phone:402-768-2575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1958225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist