Individual
LOGAN BRADLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
3100 S WOODRUFF AVE, IDAHO FALLS, ID 83404-8310
(208) 523-8879
Mailing address
3100 S WOODRUFF AVE, IDAHO FALLS, ID 83404-8310
(208) 523-8879
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
07/11/2017
Last updated
05/13/2020
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