Provider Demographics
NPI:1841957925
Name:REHDER, BRADLEY BUTLER (DPT)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:BUTLER
Last Name:REHDER
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 1:1645 VENDOLA DR
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-3044
Mailing Address - Country:US
Mailing Address - Phone:415-596-0588
Mailing Address - Fax:
Practice Address - Street 1:7100 REDWOOD BLVD STE 200
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-4110
Practice Address - Country:US
Practice Address - Phone:415-927-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA301355225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist