Provider Demographics
NPI:1598640625
Name:OWAKA, BRADLEY (DPT, PT)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:OWAKA
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12701 FAIR LAKES CIR STE 102
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-4913
Mailing Address - Country:US
Mailing Address - Phone:703-242-6460
Mailing Address - Fax:703-242-6463
Practice Address - Street 1:2960 CHAIN BRIDGE RD STE 201
Practice Address - Street 2:
Practice Address - City:OAKTON
Practice Address - State:VA
Practice Address - Zip Code:22124-3040
Practice Address - Country:US
Practice Address - Phone:703-242-6460
Practice Address - Fax:703-242-6463
Is Sole Proprietor?:No
Enumeration Date:2025-08-07
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305217309225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist