Provider Demographics
NPI:1073934394
Name:SHOCKLEY, BRADLEY (DPT, HFS)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:
Last Name:SHOCKLEY
Suffix:
Gender:M
Credentials:DPT, HFS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15433 SKYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24202-3747
Mailing Address - Country:US
Mailing Address - Phone:276-733-4505
Mailing Address - Fax:
Practice Address - Street 1:15051 HARMONY HILLS LN
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24211-7661
Practice Address - Country:US
Practice Address - Phone:276-623-1004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-05
Last Update Date:2014-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist