Provider Demographics
NPI:1598941015
Name:GOOD, BRADLEY
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:
Last Name:GOOD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:ROSSFORD
Mailing Address - State:OH
Mailing Address - Zip Code:43460-1056
Mailing Address - Country:US
Mailing Address - Phone:419-350-6744
Mailing Address - Fax:419-666-2274
Practice Address - Street 1:200 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:ROSSFORD
Practice Address - State:OH
Practice Address - Zip Code:43460-1277
Practice Address - Country:US
Practice Address - Phone:419-666-2273
Practice Address - Fax:419-666-2274
Is Sole Proprietor?:No
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3004225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant