Provider Demographics
NPI:1104668474
Name:ELDREDGE, BRADLEY P (DPT)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:P
Last Name:ELDREDGE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 362
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-1176
Mailing Address - Country:US
Mailing Address - Phone:801-980-0860
Mailing Address - Fax:801-980-0862
Practice Address - Street 1:230 N 1200 E STE 103
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-5866
Practice Address - Country:US
Practice Address - Phone:801-980-0860
Practice Address - Fax:801-980-0862
Is Sole Proprietor?:No
Enumeration Date:2024-06-08
Last Update Date:2024-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8405854-24012251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic