Provider Demographics
NPI:1023322377
Name:PLANT, BRADLEY RAY (DPT, CSCS)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:RAY
Last Name:PLANT
Suffix:
Gender:M
Credentials:DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219 TULIP LN
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-3048
Mailing Address - Country:US
Mailing Address - Phone:406-240-8458
Mailing Address - Fax:
Practice Address - Street 1:1219 TULIP LN
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-3048
Practice Address - Country:US
Practice Address - Phone:406-240-8458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-28
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR06299225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist