Provider Demographics
NPI:1962223214
Name:BRADLEY, CHAD ALYN (PTA)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:ALYN
Last Name:BRADLEY
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 1:4100 W 50 S
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46901-9702
Mailing Address - Country:US
Mailing Address - Phone:765-438-0166
Mailing Address - Fax:
Practice Address - Street 1:4100 W 50 S
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-9702
Practice Address - Country:US
Practice Address - Phone:765-438-0166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant