Provider Demographics
NPI:1376684555
Name:DALEY, BRADLEY (MPT)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:DALEY
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 TOWER CT
Mailing Address - Street 2:SUITE A
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3322
Mailing Address - Country:US
Mailing Address - Phone:847-336-1520
Mailing Address - Fax:847-336-1098
Practice Address - Street 1:30 TOWER CT
Practice Address - Street 2:SUITE A
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3322
Practice Address - Country:US
Practice Address - Phone:847-336-1520
Practice Address - Fax:847-336-1098
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070013556225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist