Provider Demographics
NPI:1952687493
Name:TREADWAY, BRADLEY LAWRENCE (ATC)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:LAWRENCE
Last Name:TREADWAY
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 1:812 GOSHEN RD
Mailing Address - Street 2:APT. F28
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-4360
Mailing Address - Country:US
Mailing Address - Phone:484-678-1990
Mailing Address - Fax:
Practice Address - Street 1:400 MONTGOMERY AVE
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4456
Practice Address - Country:US
Practice Address - Phone:484-266-3439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-28
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0039862255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer