Provider Demographics
NPI:1962759159
Name:BRADBURY, TAYLOR (PT)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:BRADBURY
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 1:435 HIGH STREET
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02090
Mailing Address - Country:US
Mailing Address - Phone:617-610-3522
Mailing Address - Fax:
Practice Address - Street 1:44 KANANI RD
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-6713
Practice Address - Country:US
Practice Address - Phone:808-633-4480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-07
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3538225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist