Provider Demographics
NPI:1275845489
Name:TROMPETER, BRADLEY A (PT)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:A
Last Name:TROMPETER
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 1:10 S CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-3400
Mailing Address - Country:US
Mailing Address - Phone:312-234-9958
Mailing Address - Fax:312-234-9962
Practice Address - Street 1:10 S CLINTON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60661-3400
Practice Address - Country:US
Practice Address - Phone:312-234-9958
Practice Address - Fax:312-234-9962
Is Sole Proprietor?:No
Enumeration Date:2010-07-06
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070017929225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00931626OtherMEDICARE RAILROAD
ILP00867643OtherMEDICARE RAILROAD
IL212989016Medicare PIN
ILP00931626OtherMEDICARE RAILROAD