Provider Demographics
NPI:1225686546
Name:FRANZEN, BRADLEY R (DPT)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:R
Last Name:FRANZEN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:BRAD
Other - Middle Name:R
Other - Last Name:FRANZEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:314 GOFF MOUNTAIN RD. (STE 13)
Mailing Address - Street 2:STE 13
Mailing Address - City:CROSS LANES
Mailing Address - State:WV
Mailing Address - Zip Code:25313
Mailing Address - Country:US
Mailing Address - Phone:304-776-5031
Mailing Address - Fax:304-204-6332
Practice Address - Street 1:314 GOFF MOUNTAIN RD. (STE 13)
Practice Address - Street 2:STE 13
Practice Address - City:CROSS LANES
Practice Address - State:WV
Practice Address - Zip Code:25313
Practice Address - Country:US
Practice Address - Phone:304-776-5031
Practice Address - Fax:304-204-6332
Is Sole Proprietor?:No
Enumeration Date:2019-08-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV004190225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist