Provider Demographics
NPI:1710125992
Name:BRADLEY, THERESA A (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:A
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15885 MEMORIAL DR APT 204
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-4122
Mailing Address - Country:US
Mailing Address - Phone:713-376-8336
Mailing Address - Fax:
Practice Address - Street 1:6600 HARWIN DR
Practice Address - Street 2:SUITE 100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-2276
Practice Address - Country:US
Practice Address - Phone:713-376-8336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-27
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT004767225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist