Individual
MR. DANIEL WILLIAM BRADLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4994 SHIFFER RD, STROUDSBURG, PA 18360-9042
(570) 688-6860
Mailing address
4994 SHIFFER RD, STROUDSBURG, PA 18360-9042
(570) 688-6860
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
PA077942
PA
171WH0202X
Home Modifications Contractor
PA077942
PA
171WV0202X
Vehicle Modifications Contractor
PA077942
PA
Other
Enumeration date
03/21/2011
Last updated
03/21/2011
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