Provider Demographics
NPI:1306425111
Name:EMERTON, BRADFORD JAMES (DPT)
Entity type:Individual
Prefix:
First Name:BRADFORD
Middle Name:JAMES
Last Name:EMERTON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 LACONIA RD
Mailing Address - Street 2:
Mailing Address - City:TILTON
Mailing Address - State:NH
Mailing Address - Zip Code:03276-5343
Mailing Address - Country:US
Mailing Address - Phone:603-717-7010
Mailing Address - Fax:603-717-7011
Practice Address - Street 1:614 LACONIA RD
Practice Address - Street 2:
Practice Address - City:TILTON
Practice Address - State:NH
Practice Address - Zip Code:03276-5343
Practice Address - Country:US
Practice Address - Phone:603-717-7010
Practice Address - Fax:603-717-7011
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH4735225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist