Provider Demographics
NPI:1972722676
Name:BRADLEY, WILLIAM JAMES LEE IV (PT)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:JAMES LEE
Last Name:BRADLEY
Suffix:IV
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:PO BOX 2428
Mailing Address - Street 2:PMB 22696
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32513-2428
Mailing Address - Country:US
Mailing Address - Phone:717-473-0209
Mailing Address - Fax:
Practice Address - Street 1:428 CHILDERS ST
Practice Address - Street 2:PMB 22696
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32534-9630
Practice Address - Country:US
Practice Address - Phone:717-473-0209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0002654225100000X
PAPT 001411E225100000X
NJ40QA01378300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist