Provider Demographics
NPI:1710937784
Name:HARVIE, BRADLEY ROSS (MSPT)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:ROSS
Last Name:HARVIE
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1137
Mailing Address - Street 2:
Mailing Address - City:ORTING
Mailing Address - State:WA
Mailing Address - Zip Code:98360-1137
Mailing Address - Country:US
Mailing Address - Phone:360-872-0315
Mailing Address - Fax:360-872-0438
Practice Address - Street 1:208 CORRIN AVENUE SOUTHWEST
Practice Address - Street 2:
Practice Address - City:ORTING
Practice Address - State:WA
Practice Address - Zip Code:98390
Practice Address - Country:US
Practice Address - Phone:360-872-0401
Practice Address - Fax:360-872-0438
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00010070225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8451767Medicaid
WA8860007Medicare PIN
WA8860008Medicare PIN