Provider Demographics
NPI:1205268729
Name:BRADLEY, MEGAN M (PT, DPT)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:M
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:M
Other - Last Name:COUTURE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1414 PIEDMONT DR E STE 100
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-7967
Mailing Address - Country:US
Mailing Address - Phone:850-270-7374
Mailing Address - Fax:850-273-5629
Practice Address - Street 1:1414 PIEDMONT DR E STE 100
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-7967
Practice Address - Country:US
Practice Address - Phone:850-270-7374
Practice Address - Fax:850-270-5629
Is Sole Proprietor?:No
Enumeration Date:2013-08-07
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT31281225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2013005667OtherPT STATE LICENSE