Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 16370 | MA |
N | 2251X0800X | Physical Therapist - Orthopedic | 16370 | MA |
NPI | 1083791743 |
---|---|
Provider Name | Susan Bradley |
First Address | Newtonville, MA 02460-1949 |
Second Address | Newtonville, MA 02460-1949 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 24/09/2021 |