Provider Demographics
NPI:1659469922
Name:LINEBERRY, BRADLEY JOSEPH (DPT)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:JOSEPH
Last Name:LINEBERRY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1123 E STUART DR
Mailing Address - Street 2:
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333-2513
Mailing Address - Country:US
Mailing Address - Phone:276-266-3149
Mailing Address - Fax:276-266-3150
Practice Address - Street 1:1123 E STUART DR
Practice Address - Street 2:
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-2513
Practice Address - Country:US
Practice Address - Phone:276-266-3149
Practice Address - Fax:276-266-3150
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204504225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV425678OtherCARELINK
WV001834986OtherMT. ST. BC/BS
WV3810005039Medicaid
WV001834986OtherMT. ST. BC/BS