Provider Demographics
NPI:1780238014
Name:ISCHINGER, BRADLEY DUKE (PTA)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:DUKE
Last Name:ISCHINGER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 W HOLLYWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99623-9424
Mailing Address - Country:US
Mailing Address - Phone:907-203-1168
Mailing Address - Fax:
Practice Address - Street 1:6701 BLONDELL DRIVE
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99623
Practice Address - Country:US
Practice Address - Phone:907-357-9755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant