Provider Demographics
NPI:1235707654
Name:BRADLEY, TONYA (PTA)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 10TH ST NE
Mailing Address - Street 2:
Mailing Address - City:ARAB
Mailing Address - State:AL
Mailing Address - Zip Code:35016-1675
Mailing Address - Country:US
Mailing Address - Phone:205-585-1051
Mailing Address - Fax:
Practice Address - Street 1:410 2ND AVE E STE C
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:AL
Practice Address - Zip Code:35121-1412
Practice Address - Country:US
Practice Address - Phone:205-274-0922
Practice Address - Fax:205-803-6600
Is Sole Proprietor?:No
Enumeration Date:2021-06-13
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL619225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant