Provider Demographics
NPI:1598265530
Name:HOESMAN, BRADLEY THOMAS (PTA)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:THOMAS
Last Name:HOESMAN
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 1:6741 TALL OAKS DR APT 2A
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-7252
Mailing Address - Country:US
Mailing Address - Phone:269-375-4366
Mailing Address - Fax:
Practice Address - Street 1:8290 W C AVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-8825
Practice Address - Country:US
Practice Address - Phone:269-343-2587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502000095225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant