Provider Demographics
NPI:1376851907
Name:SMITH, BRADLEY A (PT)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:A
Last Name:SMITH
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 1:6343 VIA DE SONRISA DEL SUR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-8211
Mailing Address - Country:US
Mailing Address - Phone:561-391-7700
Mailing Address - Fax:561-391-7733
Practice Address - Street 1:6343 VIA DE SONRISA DEL SUR
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433
Practice Address - Country:US
Practice Address - Phone:561-391-7700
Practice Address - Fax:561-391-7733
Is Sole Proprietor?:No
Enumeration Date:2010-09-16
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT17026225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist