Provider Demographics
NPI:1770685505
Name:BRADLEY, CARYN (PT, MMSC)
Entity Type:Individual
Prefix:
First Name:CARYN
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:PT, MMSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 WINDMILL HILL RD
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-3123
Mailing Address - Country:US
Mailing Address - Phone:203-488-7869
Mailing Address - Fax:
Practice Address - Street 1:32 WINDMILL HILL RD
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-3123
Practice Address - Country:US
Practice Address - Phone:203-488-7869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0058512251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics