Active NPI
Bradly Pruett, MS, ATC
- Athletic Trainer
- Richmond, VA
National Provider Identifier
1073907135
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 0126001219
- Practice address
- 1300 W Broad St
Richmond, VA 23284-9089 - Phone
- (804) 828-2321
- NPI assigned
- Mar 26, 2015
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 0126001219 | VA | Primary |
Addresses
Primary practice location
1300 W Broad St
Richmond, VA 23284-9089
Mailing address
7610 Beth Rd Apt C
Henrico, VA 23228-3539
Phone (434) 210-0935
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)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0126001219 | VA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1427328000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1427328000000",
"number": "1073907135",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7610 BETH RD APT C",
"city": "HENRICO",
"state": "VA",
"postal_code": "232283539",
"telephone_number": "434-210-0935"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1300 W BROAD ST",
"city": "RICHMOND",
"state": "VA",
"postal_code": "232849089",
"telephone_number": "804-828-2321"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRUETT",
"first_name": "BRADLY",
"credential": "MS, ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-03-26",
"last_updated": "2015-03-26",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "VA",
"license": "0126001219",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Richmond, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.