Provider Demographics
NPI:1891709838
Name:STURGIS, BRAD WILLIAM (PT)
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:WILLIAM
Last Name:STURGIS
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 1:8291 KEISTER RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-1032
Mailing Address - Country:US
Mailing Address - Phone:937-855-2992
Mailing Address - Fax:
Practice Address - Street 1:323 N BREIEL BLVD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45042-3868
Practice Address - Country:US
Practice Address - Phone:513-420-1700
Practice Address - Fax:513-420-9700
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT06126225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2270546Medicaid
OH2270546Medicaid