Provider Demographics
NPI:1184992604
Name:MUSSER, BRADLEY LOWELL (PT)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:LOWELL
Last Name:MUSSER
Suffix:
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 1:717 S STATE ST STE 900
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:MN
Mailing Address - Zip Code:56031-4400
Mailing Address - Country:US
Mailing Address - Phone:507-238-4949
Mailing Address - Fax:507-238-3365
Practice Address - Street 1:717 S STATE ST STE 900
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:MN
Practice Address - Zip Code:56031-4400
Practice Address - Country:US
Practice Address - Phone:507-238-4949
Practice Address - Fax:507-238-3365
Is Sole Proprietor?:No
Enumeration Date:2011-12-12
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03401225100000X
MN5269225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist