Individual
MR. BRADLEY KEITH DEMEUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
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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