Provider Demographics
NPI:1245538644
Name:STEVENS, BRADLEY MATHEW (DPT)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:MATHEW
Last Name:STEVENS
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 1:5247 WILLIAM STREET
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NY
Mailing Address - Zip Code:14086
Mailing Address - Country:US
Mailing Address - Phone:716-901-3106
Mailing Address - Fax:
Practice Address - Street 1:5247 WILLIAM ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:NY
Practice Address - Zip Code:14086-9673
Practice Address - Country:US
Practice Address - Phone:716-901-3106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT019714225100000X
AZ8256225100000X
NY029490225100000X
CAPT36044225100000X
CO11060225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist