Provider Demographics
NPI:1093957672
Name:FARRELL, BRADLEY MICHAEL (MS, LAT, ATC)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:MICHAEL
Last Name:FARRELL
Suffix:
Gender:M
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 SAINT MARYS ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27605-1424
Mailing Address - Country:US
Mailing Address - Phone:919-856-7810
Mailing Address - Fax:919-856-7822
Practice Address - Street 1:723 SAINT MARYS ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27605-1424
Practice Address - Country:US
Practice Address - Phone:919-856-7810
Practice Address - Fax:919-856-7822
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-30
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAT5052255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer