Provider Demographics
NPI:1831209337
Name:BRADLEY, KATHERINE J (PT)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:J
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 776
Mailing Address - Street 2:184 ROUTE 7 SOUTH
Mailing Address - City:MILTON
Mailing Address - State:VT
Mailing Address - Zip Code:05468-0776
Mailing Address - Country:US
Mailing Address - Phone:802-893-7427
Mailing Address - Fax:802-893-7429
Practice Address - Street 1:184 ROUTE 7 SOUTH
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:VT
Practice Address - Zip Code:05468-0776
Practice Address - Country:US
Practice Address - Phone:802-893-7427
Practice Address - Fax:802-893-7429
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0400002342225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1006991Medicaid
VT00028487OtherBLUE CROSS BLUE SHIELD
43V013OtherMVP HEALTH CARE
650012855OtherRAILROAD MC
VN1361Medicare PIN