Provider Demographics
NPI:1760848402
Name:SKENDZEL, BRADLEY (ATC)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:SKENDZEL
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 1:361 WHEELER DR
Mailing Address - Street 2:
Mailing Address - City:LEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60439-6147
Mailing Address - Country:US
Mailing Address - Phone:708-522-3752
Mailing Address - Fax:
Practice Address - Street 1:100 S BRAINARD AVE
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-2101
Practice Address - Country:US
Practice Address - Phone:708-579-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960028892255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer