Provider Demographics
NPI:1730327610
Name:WOO, BRADLEY C (PT)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:C
Last Name:WOO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:2166 N MOORPARK RD STE 200
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-5011
Mailing Address - Country:US
Mailing Address - Phone:805-370-1020
Mailing Address - Fax:805-370-1022
Practice Address - Street 1:2166 N MOORPARK RD STE 200
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-5011
Practice Address - Country:US
Practice Address - Phone:805-370-1020
Practice Address - Fax:805-370-1022
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-30
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT189912251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT18991OtherSTATE CA PHYSICAL THERAPY LICENSE