Provider Demographics
NPI:1922745959
Name:ROSENTHAL, BRADLEY (ATC)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:ROSENTHAL
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 BELLFLOWER BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90713-1812
Mailing Address - Country:US
Mailing Address - Phone:951-427-2522
Mailing Address - Fax:
Practice Address - Street 1:5000 BELLFLOWER BLVD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90713-1812
Practice Address - Country:US
Practice Address - Phone:951-427-2522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
20000506612255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
2000050661OtherBOARD OF CERTIFICATION FOR THE ATHLETIC TRAINER