Individual
BRADLEY GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
230 HARMONY BLVD, POOLER, GA 31322-3625
(706) 315-0402
Mailing address
230 HARMONY BLVD, POOLER, GA 31322-3625
(706) 315-0402
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA002543
GA
Other
Enumeration date
06/19/2016
Last updated
06/19/2016
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