Provider Demographics
NPI:1093518342
Name:PLANTY, BRADON MICHAEL
Entity type:Individual
Prefix:MR
First Name:BRADON
Middle Name:MICHAEL
Last Name:PLANTY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67119 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-9199
Mailing Address - Country:US
Mailing Address - Phone:541-678-2440
Mailing Address - Fax:
Practice Address - Street 1:325 NW VERMONT ST STE 101
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-1916
Practice Address - Country:US
Practice Address - Phone:541-678-2440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR21294225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist