Provider Demographics
NPI:1295811297
Name:BRADLEY, JOHN (PT)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:567 PUSEY MILL RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN UNIVERSITY
Mailing Address - State:PA
Mailing Address - Zip Code:19352-1617
Mailing Address - Country:US
Mailing Address - Phone:302-234-2288
Mailing Address - Fax:302-239-2869
Practice Address - Street 1:720 YORKLYN ROAD
Practice Address - Street 2:SUITE 150
Practice Address - City:HOCKESSIN
Practice Address - State:DE
Practice Address - Zip Code:19707
Practice Address - Country:US
Practice Address - Phone:302-234-2288
Practice Address - Fax:302-239-2869
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0000551225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE022601P91Medicare PIN