Individual
BRADLEY J AYTES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
551 LONE PINE BLVD, THE DALLES, OR 97058-9403
(541) 506-5779
Mailing address
551 LONE PINE BLVD, THE DALLES, OR 97058-9403
(541) 506-5779
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT-AT-10133470
OR
Other
Enumeration date
04/09/2012
Last updated
04/09/2012
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