Provider Demographics
NPI:1407689235
Name:GOLLIHER, BRADLEY ADAM (LMT)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:ADAM
Last Name:GOLLIHER
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4120 MOUNT LEBANON CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:ALVATON
Mailing Address - State:KY
Mailing Address - Zip Code:42122-9530
Mailing Address - Country:US
Mailing Address - Phone:270-303-9336
Mailing Address - Fax:
Practice Address - Street 1:1039 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-2181
Practice Address - Country:US
Practice Address - Phone:270-745-9399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY278224225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist