Active NPI
Samantha Bradley
- Physical Therapy Clinic/Center
- Phoenix, AZ
National Provider Identifier
1043668544
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Clinic/Center
- License
- 12208A
- Practice address
- 1012 E Willetta St
Phoenix, AZ 85006-2749 - Phone
- (602) 839-6533
- NPI assigned
- May 25, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Clinic/Center | 261QP2000X | 12208A | AZ | Primary |
Addresses
Primary practice location
1012 E Willetta St
Phoenix, AZ 85006-2749
Mailing address
1012 E Willetta St
Phoenix, AZ 85006-2749
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12208A | AZ | MD | Physical Therapy Clinic/Center |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1464134400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1464134400000",
"number": "1043668544",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1012 E WILLETTA ST",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850062749"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1012 E WILLETTA ST",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850062749",
"telephone_number": "602-839-6533"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRADLEY",
"first_name": "SAMANTHA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-05-25",
"last_updated": "2016-05-25",
"status": "A"
},
"taxonomies": [
{
"code": "261QP2000X",
"taxonomy_group": "",
"desc": "Clinic/Center, Physical Therapy",
"state": "AZ",
"license": "12208A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.