Provider Demographics
NPI:1437495728
Name:MURISON, BRADLEY S (PT, CFMT)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:S
Last Name:MURISON
Suffix:
Gender:M
Credentials:PT, CFMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3381 W MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-1008
Mailing Address - Country:US
Mailing Address - Phone:630-549-0511
Mailing Address - Fax:866-221-3400
Practice Address - Street 1:3381 W STATE ST.
Practice Address - Street 2:SUITE 100
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175
Practice Address - Country:US
Practice Address - Phone:630-549-0511
Practice Address - Fax:630-549-0512
Is Sole Proprietor?:No
Enumeration Date:2012-12-14
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-019435225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist