Provider Demographics
NPI:1902402308
Name:BRADLEY, TERRY LYNN
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:LYNN
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2213 RUSSELL AVE
Mailing Address - Street 2:
Mailing Address - City:WEST PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45663-6246
Mailing Address - Country:US
Mailing Address - Phone:740-357-8408
Mailing Address - Fax:
Practice Address - Street 1:51 HAYES ST
Practice Address - Street 2:
Practice Address - City:MINFORD
Practice Address - State:OH
Practice Address - Zip Code:45653-8634
Practice Address - Country:US
Practice Address - Phone:740-370-2527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide