Provider Demographics
NPI:1235270307
Name:CLEVELAND, BRADLEY B (PT)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:B
Last Name:CLEVELAND
Suffix:
Gender:M
Credentials:PT
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Mailing Address - Street 1:10505 19TH AVE SE
Mailing Address - Street 2:SUITE B
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-4280
Mailing Address - Country:US
Mailing Address - Phone:408-570-0510
Mailing Address - Fax:408-945-4018
Practice Address - Street 1:3719 88TH ST NE
Practice Address - Street 2:SUITE A
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-7228
Practice Address - Country:US
Practice Address - Phone:360-659-9621
Practice Address - Fax:360-659-9621
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2013-03-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAPT00000807225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8340143Medicaid
WA8340143Medicaid