Provider Demographics
NPI:1417516907
Name:BRADLEY, SCOTT ALLAN JR (PT, DPT)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:ALLAN
Last Name:BRADLEY
Suffix:JR
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14411 METRO PKWY UNIT 102
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4365
Mailing Address - Country:US
Mailing Address - Phone:239-292-6498
Mailing Address - Fax:
Practice Address - Street 1:15751 SAN CARLOS BLVD STE 4
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-3315
Practice Address - Country:US
Practice Address - Phone:239-337-2739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT34297225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist