Provider Demographics
NPI:1811209364
Name:BRADSHAW, GREGORY JOHN (PT)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:JOHN
Last Name:BRADSHAW
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 E WARWICK RD
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60074-3873
Mailing Address - Country:US
Mailing Address - Phone:847-496-7331
Mailing Address - Fax:
Practice Address - Street 1:1875 DEMPSTER ST
Practice Address - Street 2:SUITE G10
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1186
Practice Address - Country:US
Practice Address - Phone:847-723-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070009447282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital