Provider Demographics
NPI:1487014122
Name:BRADLEY, EMILY ANN (LAT, ATC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ANN
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1788 SUFFOLK DOWNS
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-6441
Mailing Address - Country:US
Mailing Address - Phone:610-883-3044
Mailing Address - Fax:
Practice Address - Street 1:1788 SUFFOLK DOWNS
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-6441
Practice Address - Country:US
Practice Address - Phone:610-883-3044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-23
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0061172255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer