Individual
DOUGLAS BRADLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
1500 AIRPORT RD STE 5, KALISPELL, MT 59901-5748
(406) 250-0707
Mailing address
PO BOX 933, KALISPELL, MT 59903-0933
(406) 250-0707
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
293
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
329460
MEDICAID WAIVER
MT
Enumeration date
06/16/2016
Last updated
04/11/2025
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