Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT 23700 | CA |
N | 2251E1200X | Ergonomics | PT 23700 | CA |
N | 225XE1200X | Ergonomics | PT 23700 | CA |
NPI | 1205926938 |
---|---|
Provider Name | Dr. Kirk Thomas Bradley |
First Address | Lockeford, CA 95237-9545 |
Second Address | Stockton, CA 95207-6407 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PT0237000 | (05) | CA |