Provider Demographics
NPI:1225795453
Name:HUFF, BRADLEY SCOTT (MMT)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:SCOTT
Last Name:HUFF
Suffix:
Gender:M
Credentials:MMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4427
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72702-4427
Mailing Address - Country:US
Mailing Address - Phone:479-445-3267
Mailing Address - Fax:
Practice Address - Street 1:1792 E JOYCE BLVD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5253
Practice Address - Country:US
Practice Address - Phone:479-445-3267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR6878225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist