Provider Demographics
NPI:1477966174
Name:PIERSON, BRADLEY MARK (ATC)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:MARK
Last Name:PIERSON
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 W BANCROFT ST
Mailing Address - Street 2:MAIL STOP 302
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-3328
Mailing Address - Country:US
Mailing Address - Phone:419-530-7915
Mailing Address - Fax:416-530-2570
Practice Address - Street 1:2801 W BANCROFT ST
Practice Address - Street 2:MAIL STOP 302
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3328
Practice Address - Country:US
Practice Address - Phone:419-530-7915
Practice Address - Fax:416-530-2570
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0041942255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer