Individual
JENNIFER BRADLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
3200 LABORE RD STE 102, VADNAIS HEIGHTS, MN 55110-5189
(952) 835-4512
Mailing address
7815 3RD ST N STE 203, OAKDALE, MN 55128-5443
(952) 835-4512
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
10064
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10064
MN BOARD OF PT
MN
Enumeration date
08/10/2015
Last updated
08/10/2015
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