Provider Demographics
NPI:1538870225
Name:BRADLEY, JOSEPH DAVID (DPT)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:DAVID
Last Name:BRADLEY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8211 SAN ANGELO DR APT M12
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-7296
Mailing Address - Country:US
Mailing Address - Phone:408-505-9197
Mailing Address - Fax:
Practice Address - Street 1:15775 LAGUNA CANYON RD
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3189
Practice Address - Country:US
Practice Address - Phone:949-333-3833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA303371225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist