Provider Demographics
NPI:1881140069
Name:BRADLEY, ANDREA JEAN
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:JEAN
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:ANDREA
Other - Middle Name:JEAN
Other - Last Name:ROTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:2400 MCVEY CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-2835
Mailing Address - Country:US
Mailing Address - Phone:614-284-6328
Mailing Address - Fax:
Practice Address - Street 1:2400 MCVEY CT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-2835
Practice Address - Country:US
Practice Address - Phone:614-284-6328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-29
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH088712251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics