Individual
MR. BRADLEY JEFF STEPHENSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
2405D E CHAMBERS DR, BOONEVILLE, MS 38829-8927
(662) 720-7050
(662) 720-7055
Mailing address
2405D E CHAMBERS DR, BOONEVILLE, MS 38829-8927
(662) 720-7050
(662) 720-7055
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT3039
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000122501
—
MS
05
—
03256731
—
MS
Enumeration date
01/31/2007
Last updated
11/07/2022
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