Individual
DOUGLAS BRADLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, CSCS
Contact information
Practice address
313 N WEBER RD, BOLINGBROOK, IL 60490-1569
(630) 771-0850
(630) 771-0852
Mailing address
2001 BUTTERFIELD RD STE 1600, DOWNERS GROVE, IL 60515-1211
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
05007954A
IN
225100000X
Physical Therapist
Primary
070009229
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01622333
BLUE CROSS BLUE SHIELD ID
—
01
—
7454077
AETNA
—
Enumeration date
09/05/2007
Last updated
01/08/2025
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