Provider Demographics
NPI:1669836888
Name:BUNTEN, BRADLEY (ATC)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:BUNTEN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2270 MEADOWLAKE RD APT 614
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-2673
Mailing Address - Country:US
Mailing Address - Phone:314-304-1173
Mailing Address - Fax:
Practice Address - Street 1:1600 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-4115
Practice Address - Country:US
Practice Address - Phone:314-304-1173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-13
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer