Provider Demographics
NPI:1366458325
Name:ABRAMS, BRADLEY BRUCE (PT)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:BRUCE
Last Name:ABRAMS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1310 PAPIN ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63103-3132
Mailing Address - Country:US
Mailing Address - Phone:314-255-9749
Mailing Address - Fax:314-335-7770
Practice Address - Street 1:1310 PAPIN ST
Practice Address - Street 2:SUITE 109
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63103-3132
Practice Address - Country:US
Practice Address - Phone:314-255-9749
Practice Address - Fax:314-335-7770
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2014-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005012155225100000X
IL070-014647225100000X
OHPT 006742225100000X
UT5668088-2401225100000X
FLPT 16203225100000X
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO220854815Medicare ID - Type UnspecifiedMEDICARE