Provider Demographics
NPI:1972909901
Name:RICHIE, BRADLEY CARL (DPT)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:CARL
Last Name:RICHIE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 5TH AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-2607
Mailing Address - Country:US
Mailing Address - Phone:717-747-8350
Mailing Address - Fax:717-718-3150
Practice Address - Street 1:470 EISENHOWER DR
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-5248
Practice Address - Country:US
Practice Address - Phone:717-747-8350
Practice Address - Fax:717-718-3150
Is Sole Proprietor?:No
Enumeration Date:2014-11-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT024064225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist