Individual
BRADLEY DALE PEARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPT
Contact information
Practice address
720 S WOODRUFF AVE, IDAHO FALLS, ID 83401-5285
(208) 552-5025
(208) 552-5029
Mailing address
720 S WOODRUFF AVE, IDAHO FALLS, ID 83401-5285
(208) 552-5025
(208) 552-5029
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
PT-1125
ID
Other
Enumeration date
10/28/2009
Last updated
10/28/2009
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