Provider Demographics
NPI:1841292844
Name:HARPER, BRADLEY NEIL (PT)
Entity type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:NEIL
Last Name:HARPER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3004 W UNIVERSITY BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-2998
Mailing Address - Country:US
Mailing Address - Phone:580-920-2231
Mailing Address - Fax:580-920-2242
Practice Address - Street 1:3004 W UNIVERSITY BLVD
Practice Address - Street 2:STE 101
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-2998
Practice Address - Country:US
Practice Address - Phone:580-920-2231
Practice Address - Fax:580-920-2242
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT2379225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK3523320OtherCIGNA
OK100834510BMedicaid
OK249517501OtherHUMANA GOLD CHOICE
OK611622500OtherUS DEPT OF LABOR
OKP00239087OtherRR MEDICARE
OK3523320OtherCIGNA
OK$$$$$$$$$002OtherBCBS