Collin Bradley, | |
24560 Southpoint Dr, Aldie, VA 20105-3510 | |
(571) 370-3686 | |
Not Available |
Full Name | Collin Bradley |
---|---|
Gender | Male |
Speciality | Physical Therapist |
Location | 24560 Southpoint Dr, Aldie, Virginia |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1891454088 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
225100000X | Physical Therapist | PENDING (Virginia) | Primary |
Provider Name | Jackson Clinics Limited Partnership |
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Provider Type | Part B Supplier - Physical/occupational Therapy Group In Private Practice |
Provider Identifiers | NPI Number: 1639594831 PECOS PAC ID: 2860623295 Enrollment ID: O20140327000554 |
Mailing Address | Practice Location Address |
---|---|
Collin Bradley, Po Box 1769, Middleburg, VA 20118-1769 Ph: (703) 729-7920 | Collin Bradley, 24560 Southpoint Dr, Aldie, VA 20105-3510 Ph: (571) 370-3686 |
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