Individual
KATHLEEN MARIE BRADLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4629
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
299843
—
OR
01
—
333058
PROVIDENCE
—
01
—
5512827
FIRST HEALTH
—
01
—
804449008
BCBS
OR
01
—
H254808
PACIFIC SOURCE
OR
Enumeration date
11/15/2005
Last updated
08/16/2026
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