Provider Demographics
NPI:1588312672
Name:PARMELY, BRADLY (PTA)
Entity type:Individual
Prefix:
First Name:BRADLY
Middle Name:
Last Name:PARMELY
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 1:3018 SOARING EAGLE WAY
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-5197
Mailing Address - Country:US
Mailing Address - Phone:731-439-6025
Mailing Address - Fax:
Practice Address - Street 1:1653 MOORESVILLE HWY
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:TN
Practice Address - Zip Code:37091-1413
Practice Address - Country:US
Practice Address - Phone:931-359-4506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPTA0000007542225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant