Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT26669 | CA |
N | 2251X0800X | Physical Therapist - Orthopedic | PT26669 | CA |
NPI | 1073695771 |
---|---|
Provider Name | Jeffery K Bradley |
First Address | Beverly Hills, CA 90211-1769 |
Second Address | Beverly Hills, CA 90211-6001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2006 |
Last Update Date | 08/07/2007 |