Individual
BRADLEY S MICHALKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
441 S REDWOOD RD, SALT LAKE CITY, UT 84104-3539
(801) 975-1403
Mailing address
PO BOX 70689, SALT LAKE CITY, UT 84170-0689
(801) 987-8602
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
11250165-2401
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11250165-2401
UTAH OCCUPATIONAL THERAPIST LICENSE
UT
Enumeration date
05/22/2019
Last updated
05/22/2019
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