Provider Demographics
NPI:1821033093
Name:BRYAN, BRADLEY KERR (MS,PT, CHT)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:KERR
Last Name:BRYAN
Suffix:
Gender:M
Credentials:MS,PT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 BOULDERS PKWY
Mailing Address - Street 2:STE 200
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4067
Mailing Address - Country:US
Mailing Address - Phone:804-915-4602
Mailing Address - Fax:804-327-8496
Practice Address - Street 1:500 HIOAKS RD
Practice Address - Street 2:SUITE B
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-4061
Practice Address - Country:US
Practice Address - Phone:804-330-8165
Practice Address - Fax:804-330-5829
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305001814225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA194769OtherANTHEM CHIPPENHAM OT
VA010067286Medicaid
VA258462OtherSOUTHERN HEALTH
VA98999OtherOPTIMA HEALTH
VA0472640006Medicare NSC
VA98999OtherOPTIMA HEALTH