Provider Demographics
NPI:1851469100
Name:BRADLEY, TODD A (DPT)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:A
Last Name:BRADLEY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 E CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:OELWEIN
Mailing Address - State:IA
Mailing Address - Zip Code:50662-1940
Mailing Address - Country:US
Mailing Address - Phone:319-283-2002
Mailing Address - Fax:319-283-2015
Practice Address - Street 1:204 E CHARLES ST
Practice Address - Street 2:
Practice Address - City:OELWEIN
Practice Address - State:IA
Practice Address - Zip Code:50662-1940
Practice Address - Country:US
Practice Address - Phone:319-283-2002
Practice Address - Fax:319-283-2015
Is Sole Proprietor?:No
Enumeration Date:2006-12-02
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP00709294OtherRR MEDICARE
IA1811052350Medicaid
IA1811052350OtherWELLMARK BCBS
IAIB1211001Medicare PIN