Provider Demographics
NPI:1841236031
Name:BRAGDON, DAVID PATRICK (PT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:PATRICK
Last Name:BRAGDON
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 1:323 CHANCELLOR ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-2225
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:REAR 238 INDIANA STREET
Practice Address - Street 2:
Practice Address - City:SEWARD
Practice Address - State:PA
Practice Address - Zip Code:15954
Practice Address - Country:US
Practice Address - Phone:814-446-5126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT015940225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist