Provider Demographics
NPI:1215277660
Name:RADLE, BRADLY DOUGLAS (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:BRADLY
Middle Name:DOUGLAS
Last Name:RADLE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785 MILL SHADOW DR
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-4171
Mailing Address - Country:US
Mailing Address - Phone:801-549-8724
Mailing Address - Fax:
Practice Address - Street 1:5850 POLARIS AVE STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-3185
Practice Address - Country:US
Practice Address - Phone:702-739-9957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2810225100000X
UT8510286-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist