Provider Demographics
NPI:1518107150
Name:BRADLEY, KAREN S (ATC, LMT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:S
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:ATC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GORHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03581-1622
Mailing Address - Country:US
Mailing Address - Phone:603-466-3679
Mailing Address - Fax:
Practice Address - Street 1:74 MAIN ST
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:NH
Practice Address - Zip Code:03581-1622
Practice Address - Country:US
Practice Address - Phone:603-466-3679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-23
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2218M172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist