Individual
MR. BRADLEY KEITH DEMEUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
5246 N ROYAL DR STE B, TRAVERSE CITY, MI 49684-6984
(231) 929-0303
(231) 929-0305
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501015699
MI
2251X0800X
Orthopedic Physical Therapist
5501015699
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P01332469
RAILROAD MEDICARE
MI
Enumeration date
07/23/2012
Last updated
08/22/2014
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