Provider Demographics
NPI:1821221391
Name:BRADLEY PHYSICAL THERAPY
Entity Type:Organization
Organization Name:BRADLEY PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BISGROVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-845-3775
Mailing Address - Street 1:2003 ROBIN LN
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-7158
Mailing Address - Country:US
Mailing Address - Phone:715-845-3775
Mailing Address - Fax:715-848-9015
Practice Address - Street 1:2003 ROBIN LANE
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-7158
Practice Address - Country:US
Practice Address - Phone:715-845-3775
Practice Address - Fax:715-848-9015
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRADLEY CHIROPRACTIC & PHYSICAL THERAPY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-31
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2469-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty