Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant |
NPI | 1003473315 |
---|---|
Provider Name | Lori Nicole Bradsher |
First Address | Raleigh, NC 27614-7375 |
Second Address | Raleigh, NC 27614-7383 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2019 |
Last Update Date | 22/05/2019 |