Provider Demographics
NPI:1588669907
Name:ORR, BRADLEY DOUGLAS (PT, OCS)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:DOUGLAS
Last Name:ORR
Suffix:
Gender:M
Credentials:PT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1460
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57402-1460
Mailing Address - Country:US
Mailing Address - Phone:605-225-0430
Mailing Address - Fax:605-225-0876
Practice Address - Street 1:701 8TH AVE NW
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-1865
Practice Address - Country:US
Practice Address - Phone:605-225-0430
Practice Address - Fax:605-225-0876
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS831460Medicaid
SD436502Medicare Oscar/Certification
SD1108470001Medicare NSC
SD650013620Medicare PIN