1184040743 NPI number — TREVOR JOHN WILLIAM BRADSHAW DPT

Table of content: TREVOR JOHN WILLIAM BRADSHAW DPT (NPI 1184040743)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184040743 NPI number — TREVOR JOHN WILLIAM BRADSHAW DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRADSHAW
Provider First Name:
TREVOR
Provider Middle Name:
JOHN WILLIAM
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184040743
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/06/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1750 5TH AVE
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
YORK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17403-2607
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-747-8350
Provider Business Mailing Address Fax Number:
717-718-3150

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1855 POWDER MILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YORK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17402-4723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-747-8350
Provider Business Practice Location Address Fax Number:
717-718-3150
Provider Enumeration Date:
03/06/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT023383 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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