Provider Demographics
NPI:1316231384
Name:HARDING, BRAD WAYNE (PT)
Entity Type:Individual
Prefix:MR
First Name:BRAD
Middle Name:WAYNE
Last Name:HARDING
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 1:170 BEAVERDAM LOOP RD
Mailing Address - Street 2:
Mailing Address - City:CANDLER
Mailing Address - State:NC
Mailing Address - Zip Code:28715-9238
Mailing Address - Country:US
Mailing Address - Phone:830-456-3865
Mailing Address - Fax:
Practice Address - Street 1:170 BEAVERDAM LOOP RD
Practice Address - Street 2:
Practice Address - City:CANDLER
Practice Address - State:NC
Practice Address - Zip Code:28715-9238
Practice Address - Country:US
Practice Address - Phone:830-456-3865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP13152225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist