Provider Demographics
NPI:1578955399
Name:BRISCOE, BRADLEY HAMILTON (PTA)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:HAMILTON
Last Name:BRISCOE
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 GLENSBORO ROAD SUITE #1
Mailing Address - Street 2:CENTRAL KENTUCKY PHYSICAL THERAPY 1NC DBA LAWRENCEBURG
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40342-9084
Mailing Address - Country:US
Mailing Address - Phone:502-839-9755
Mailing Address - Fax:502-839-9763
Practice Address - Street 1:1100 GLENSBORO ROAD SUITE #1
Practice Address - Street 2:CENTRAL KENTUCKY PHYSICAL THERAPY 1NC DBA LAWRENCEBURG
Practice Address - City:LAWRENCEBURG
Practice Address - State:KY
Practice Address - Zip Code:40342-9084
Practice Address - Country:US
Practice Address - Phone:502-839-9755
Practice Address - Fax:502-839-9763
Is Sole Proprietor?:No
Enumeration Date:2015-03-03
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA01619225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYA01619OtherPTA LICENSE #