Organization
BRADSHAW PHYSICAL THERAPY & WELLNESS CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROGER B BRADSHAW P.T. (PHYSICAL THERAPIST BUSINESS OWNER)
(541) 482-3126
Entity
Organization
Contact information
Practice address
223 WINTERSAGE CIR UNIT A, TALENT, OR 97540-9515
(541) 482-3126
(541) 482-0593
Mailing address
223 WINTERSAGE CIR UNIT A, TALENT, OR 97540-9566
(541) 482-3126
(541) 482-0593
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
2192
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
122002900
US DEPT. OF LABOR
OR
05
—
230041
—
OR
01
—
838049001
BCBS
OR
01
—
L5250-01
PACIFICSOURCE
OR
Enumeration date
12/04/2006
Last updated
02/01/2019
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