Provider Demographics
NPI:1043541899
Name:BRADLEY, TOM (ATC, CES)
Entity type:Individual
Prefix:MR
First Name:TOM
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:M
Credentials:ATC, CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1252 S ALTON CT
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-2321
Mailing Address - Country:US
Mailing Address - Phone:303-506-9791
Mailing Address - Fax:
Practice Address - Street 1:1252 S ALTON CT
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80247-2321
Practice Address - Country:US
Practice Address - Phone:303-506-9791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-19
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer