Provider Demographics
NPI:1104875236
Name:RINEHART, BRADLEY (PT)
Entity type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:
Last Name:RINEHART
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 BRIGHAM RD
Mailing Address - Street 2:
Mailing Address - City:FREDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:14063-1000
Mailing Address - Country:US
Mailing Address - Phone:716-679-7447
Mailing Address - Fax:716-679-7446
Practice Address - Street 1:12 BRIGHAM RD
Practice Address - Street 2:
Practice Address - City:FREDONIA
Practice Address - State:NY
Practice Address - Zip Code:14063-1000
Practice Address - Country:US
Practice Address - Phone:716-679-7447
Practice Address - Fax:716-679-7446
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY9395740OtherINDEPENDENT HEALTH
NY000528243001OtherBLUE CROSS/BLUE SHIELD
NY817418OtherMANAGED PHYSICAL NETWORK
NYAA1277Medicare ID - Type Unspecified