Provider Demographics
NPI:1700927449
Name:BRADLEY-POPOVICH, GREG EDWARD (DPT)
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:EDWARD
Last Name:BRADLEY-POPOVICH
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 1:9755 SW BARNES RD
Mailing Address - Street 2:SUITE 510
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6651
Mailing Address - Country:US
Mailing Address - Phone:503-227-8087
Mailing Address - Fax:503-227-8175
Practice Address - Street 1:9755 SW BARNES RD
Practice Address - Street 2:SUITE 510
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6651
Practice Address - Country:US
Practice Address - Phone:503-227-8087
Practice Address - Fax:503-227-8175
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist