Provider Demographics
NPI:1144775156
Name:CASPER, BRADLEY
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:CASPER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 PRE EMPTION RD
Mailing Address - Street 2:STE 3
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-2042
Mailing Address - Country:US
Mailing Address - Phone:585-637-0790
Mailing Address - Fax:585-637-3572
Practice Address - Street 1:92 WEST AVE
Practice Address - Street 2:
Practice Address - City:BROCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14420-1306
Practice Address - Country:US
Practice Address - Phone:585-637-0790
Practice Address - Fax:585-637-3572
Is Sole Proprietor?:No
Enumeration Date:2016-08-19
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040391225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist