Provider Demographics
NPI:1205854643
Name:BRADBURY, ROBERT J (PT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:BRADBURY
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 1:1632 116TH AVE NE
Mailing Address - Street 2:SUITE C
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3035
Mailing Address - Country:US
Mailing Address - Phone:425-462-9800
Mailing Address - Fax:
Practice Address - Street 1:11400 SE 6TH ST
Practice Address - Street 2:SUITE 130
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-6423
Practice Address - Country:US
Practice Address - Phone:425-455-0699
Practice Address - Fax:425-455-1541
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 21269225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ01499Medicare UPIN
CAW20481Medicare PIN