Provider Demographics
NPI:1134397045
Name:YOTTY, BRADLEY B (DPT)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:B
Last Name:YOTTY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:BRAD
Other - Middle Name:B
Other - Last Name:YOTTY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:2008 CEDAR PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-2285
Mailing Address - Country:US
Mailing Address - Phone:563-264-8638
Mailing Address - Fax:563-264-8639
Practice Address - Street 1:10118 MAPLE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-5555
Practice Address - Country:US
Practice Address - Phone:402-939-7939
Practice Address - Fax:402-939-7940
Is Sole Proprietor?:No
Enumeration Date:2008-02-13
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004155225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA004155OtherIOWA PT LICENSE NO
IAI18344005Medicare UPIN