Provider Demographics
NPI:1548614381
Name:BRADBURY EARLY INTERVENTION, PLLC
Entity Type:Organization
Organization Name:BRADBURY EARLY INTERVENTION, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARTI
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADBURY
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:270-307-6399
Mailing Address - Street 1:1636 DEER LN APT 3
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-1269
Mailing Address - Country:US
Mailing Address - Phone:270-307-6399
Mailing Address - Fax:
Practice Address - Street 1:1636 DEER LN APT 3
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-1269
Practice Address - Country:US
Practice Address - Phone:270-307-6399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-18
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY006170252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency