Provider Demographics
NPI:1215224928
Name:MEYER, BRADLEY W (PT)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:W
Last Name:MEYER
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 1:451 E ERIE ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-6159
Mailing Address - Country:US
Mailing Address - Phone:414-272-8482
Mailing Address - Fax:414-272-2880
Practice Address - Street 1:451 E ERIE ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-6159
Practice Address - Country:US
Practice Address - Phone:414-272-8482
Practice Address - Fax:414-272-2880
Is Sole Proprietor?:No
Enumeration Date:2011-07-01
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11747-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100016113Medicaid
WI100016113Medicaid