Provider Demographics
NPI:1932320645
Name:BRADLEY, AMY
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
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 1:561 N POLK ST
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28134-8563
Mailing Address - Country:US
Mailing Address - Phone:704-889-7828
Mailing Address - Fax:704-889-7832
Practice Address - Street 1:561 N POLK ST
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28134-8563
Practice Address - Country:US
Practice Address - Phone:704-889-7828
Practice Address - Fax:704-889-7832
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC84302251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics