Individual
BRENT BRADLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
18135 COTTONWOOD, SUNRIVER, OR 97707-9317
(541) 390-7518
(541) 389-6272
Mailing address
1431 NW ITHACA AVE, BEND, OR 97701-2113
(541) 390-7518
(541) 389-6272
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4661
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
183072
—
OR
Enumeration date
11/21/2005
Last updated
10/18/2007
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