# MR. BRADLEY JEFF STEPHENSON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1134266901
- **Gender:** Man
- **Credential:** PT

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | PT3039 | MS | Yes |

## Other

- **Enumeration date:** 01/31/2007
- **Last updated:** 11/07/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 000122501 | — | MS |
| 05 | — | 03256731 | — | MS |