Provider Demographics
NPI:1124743505
Name:REDMOND, BRADLEY L (DPT, PT)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:L
Last Name:REDMOND
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16845 W HUNNICUT RD
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47327-9733
Mailing Address - Country:US
Mailing Address - Phone:765-238-1112
Mailing Address - Fax:
Practice Address - Street 1:16845 W HUNNICUT RD
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE CITY
Practice Address - State:IN
Practice Address - Zip Code:47327-9733
Practice Address - Country:US
Practice Address - Phone:765-238-1112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-07
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05010657A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist