Provider Demographics
NPI:1689909186
Name:BRADLEY, MARY JOANNE (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:JOANNE
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 HOOSICK ST
Mailing Address - Street 2:
Mailing Address - City:HOOSICK FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12090-1713
Mailing Address - Country:US
Mailing Address - Phone:518-686-5010
Mailing Address - Fax:
Practice Address - Street 1:4976 ROUTE 7
Practice Address - Street 2:
Practice Address - City:HOOSICK
Practice Address - State:NY
Practice Address - Zip Code:12089
Practice Address - Country:US
Practice Address - Phone:518-686-5010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-16
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032058-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist