Individual
MR. BRADLEY C. BRUSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
A.T.C., C.S.C.S.
Contact information
Practice address
305 W JACKSON ST, SUITE LL02, CARBONDALE, IL 62901-1474
(618) 549-0721
(618) 529-0403
Mailing address
507 S GREEN ST, ANNA, IL 62906-1103
(618) 833-4441
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096-000308
IL
Other
Enumeration date
03/09/2006
Last updated
12/22/2008
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