Provider Demographics
NPI:1285964957
Name:GARRETT, BRADLEY WILLIAM (PTA)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:WILLIAM
Last Name:GARRETT
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-2713
Mailing Address - Country:US
Mailing Address - Phone:270-724-9120
Mailing Address - Fax:
Practice Address - Street 1:1024 N ELM ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-2713
Practice Address - Country:US
Practice Address - Phone:270-724-9120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-02
Last Update Date:2010-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA02491225200000X
IN06002965A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant