Provider Demographics
NPI:1780612085
Name:BRADLEY, ALTHEA MIR MINNA (MPH, RD, LDN)
Entity type:Individual
Prefix:MRS
First Name:ALTHEA
Middle Name:MIR MINNA
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:MPH, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 GLENGARY DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15215-1138
Mailing Address - Country:US
Mailing Address - Phone:412-897-0299
Mailing Address - Fax:
Practice Address - Street 1:623 GLENGARY DR
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15215-1138
Practice Address - Country:US
Practice Address - Phone:412-897-0299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN003841133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered