Provider Demographics
NPI:1457774929
Name:BRADSHER, MATT (DPT)
Entity type:Individual
Prefix:MR
First Name:MATT
Middle Name:
Last Name:BRADSHER
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 1:23711 HIGHWAY 10
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-4446
Mailing Address - Country:US
Mailing Address - Phone:501-658-9822
Mailing Address - Fax:
Practice Address - Street 1:23711 HIGHWAY 10
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-4446
Practice Address - Country:US
Practice Address - Phone:501-658-9822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-03
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3496225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist