Provider Demographics
NPI:1124007141
Name:HIRL, BRADLEY C (PT)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:C
Last Name:HIRL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 53RD AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-7565
Mailing Address - Country:US
Mailing Address - Phone:563-322-0971
Mailing Address - Fax:563-459-4098
Practice Address - Street 1:2900 S 25TH ST STE B2
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-7250
Practice Address - Country:US
Practice Address - Phone:563-278-8830
Practice Address - Fax:563-278-8831
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01856225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP00283914OtherRR MEDICARE
IA39017OtherBCBS
F247755OtherMIDLANDS CHOICE
F247755OtherMIDLANDS CHOICE