Bradley Thomas Ilk

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

2740-19 Issued in WI

Practice address

2626 N 76TH St Ste 105
Wauwatosa, WI 53213-1137

Phone

(414) 774-7794

Fax

(414) 607-3971

NPI assigned

Aug 10, 2018

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1533859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1533859200000",
    "number": "1124507165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2626 N 76TH ST STE 105",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532131137",
            "telephone_number": "414-774-7794",
            "fax_number": "414-607-3971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2626 N 76TH ST STE 105",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532131137",
            "telephone_number": "414-774-7794",
            "fax_number": "414-607-3971"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6211 Durand Ave Ste 202",
            "address_purpose": "LOCATION",
            "city": "Mount Pleasant",
            "state": "WI",
            "postal_code": "534064956",
            "country_code": "US",
            "telephone_number": "262-898-0611",
            "fax_number": "262-898-3951",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ILK",
        "first_name": "BRADLEY",
        "middle_name": "THOMAS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-08-10",
        "last_updated": "2018-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "WI",
            "license": "2740-19",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapy Assistant in Wauwatosa, WI
• Providers in Wauwatosa, WI by specialty
• Physical Therapy Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.