Provider Demographics
NPI:1083791743
Name:BRADLEY, SUSAN (DPT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:SALTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:108 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:NEWTONVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02460-1949
Mailing Address - Country:US
Mailing Address - Phone:617-256-6205
Mailing Address - Fax:
Practice Address - Street 1:108 MADISON AVE
Practice Address - Street 2:
Practice Address - City:NEWTONVILLE
Practice Address - State:MA
Practice Address - Zip Code:02460-1949
Practice Address - Country:US
Practice Address - Phone:617-256-6205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16370225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY69513Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER NUMBE