Provider Demographics
NPI:1164067211
Name:BRADLEY, RAYNA K
Entity Type:Individual
Prefix:
First Name:RAYNA
Middle Name:K
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1295 LAKE ROGERS CIR
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-7211
Mailing Address - Country:US
Mailing Address - Phone:601-941-6928
Mailing Address - Fax:
Practice Address - Street 1:148 LAKE AVE
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-6424
Practice Address - Country:US
Practice Address - Phone:601-941-6928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-13
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist