Provider Demographics
NPI:1679516637
Name:CONDER, BRADLEY LAWRENCE (PT, DPT, OCS)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:LAWRENCE
Last Name:CONDER
Suffix:
Gender:M
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 S ENGLISH STATION RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-4160
Mailing Address - Country:US
Mailing Address - Phone:502-245-1136
Mailing Address - Fax:502-245-1146
Practice Address - Street 1:175 S ENGLISH STATION RD
Practice Address - Street 2:SUITE 220
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-4160
Practice Address - Country:US
Practice Address - Phone:502-245-1136
Practice Address - Fax:502-245-1146
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY004698225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY004698OtherKY STATE LICENSE
KY004698OtherKY STATE LICENSE