Provider Demographics
NPI:1437628047
Name:BELCHER, BRADLEY (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:BELCHER
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1891 E 600 S
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:IN
Mailing Address - Zip Code:46938-1536
Mailing Address - Country:US
Mailing Address - Phone:765-667-4096
Mailing Address - Fax:
Practice Address - Street 1:1891 E 600 S
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:IN
Practice Address - Zip Code:46938-1536
Practice Address - Country:US
Practice Address - Phone:765-667-4096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-13
Last Update Date:2020-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36003359A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer