Provider Demographics
NPI:1194319921
Name:STROTT, BRADLEY (PT, DPT, MA)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:STROTT
Suffix:
Gender:M
Credentials:PT, DPT, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 WINDRUSH RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-2593
Mailing Address - Country:US
Mailing Address - Phone:704-577-4186
Mailing Address - Fax:
Practice Address - Street 1:101 WINDRUSH RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-2593
Practice Address - Country:US
Practice Address - Phone:704-577-4186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP14748225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist