Provider Demographics
NPI:1821044249
Name:NOLIN, BRADLEY (MPT)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:
Last Name:NOLIN
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 DRIFTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-4813
Mailing Address - Country:US
Mailing Address - Phone:561-632-2160
Mailing Address - Fax:561-842-6458
Practice Address - Street 1:11550 MIRASOL WAY
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33418-6208
Practice Address - Country:US
Practice Address - Phone:561-632-2160
Practice Address - Fax:561-842-6458
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 20257225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU5308Medicare UPIN