Provider Demographics
NPI:1366808347
Name:BRADLEY, JACK BRYSON JR (ATS)
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:BRYSON
Last Name:BRADLEY
Suffix:JR
Gender:M
Credentials:ATS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 APPELDOORN CIR
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-6109
Mailing Address - Country:US
Mailing Address - Phone:828-676-9291
Mailing Address - Fax:
Practice Address - Street 1:625 APPELDOORN CIR
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-6109
Practice Address - Country:US
Practice Address - Phone:828-676-9291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer