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Individual

BLAKE BRADISH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DPT

Contact information

Practice address
1001 EAST MAIN STREET, SUITE 510, BRADFORD, PA 16701-3101
(814) 596-0016
(814) 596-0024
Mailing address
430 INNOVATION DR, BLAIRSVILLE, PA 15717-8096
(724) 343-4060
(724) 343-4069

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT025328
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1019541330001
PA
Enumeration date
09/21/2016
Last updated
09/21/2016
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