Provider Demographics
NPI:1134135205
Name:MORIN, BRADLEY D (MS PT)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:D
Last Name:MORIN
Suffix:
Gender:M
Credentials:MS PT
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Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7300 SECOR RD
Practice Address - Street 2:
Practice Address - City:LAMBERTVILLE
Practice Address - State:MI
Practice Address - Zip Code:48144-9376
Practice Address - Country:US
Practice Address - Phone:734-854-1260
Practice Address - Fax:734-854-3581
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5501010355225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP01391767OtherRR MEDICARE
MIP01391767OtherRR MEDICARE