Provider Demographics
NPI:1932733219
Name:BAGLEY, ANTHONY BRANDON (PT , DPT)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:BRANDON
Last Name:BAGLEY
Suffix:
Gender:M
Credentials:PT , DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14603 DONEGAL CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-3229
Mailing Address - Country:US
Mailing Address - Phone:301-518-2553
Mailing Address - Fax:
Practice Address - Street 1:1535 UNIVERSITY BLVD E STE D
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20783-4694
Practice Address - Country:US
Practice Address - Phone:301-434-1850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-26
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
MD27873225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist