Active NPI
Bradley Scarborough, LPTA
- Physical Therapy Assistant
- Pueblo, CO
National Provider Identifier
1346839206
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- CP003218A
- Practice address
- 2611 Jones Ave
Pueblo, CO 81004-2650 - Phone
- (719) 564-1735
- NPI assigned
- Jan 14, 2021
- Last updated
- Jan 14, 2021
- Sex
- Male
- 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 Assistant | 225200000X | CP003218A | CO | Primary |
Addresses
Primary practice location
2611 Jones Ave
Pueblo, CO 81004-2650
Mailing address
904 Poplar Dr
Brandon, MS 39042-2906
Phone (601) 278-9985
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CP003218A | CO | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1610582400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1610582400000",
"number": "1346839206",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "904 POPLAR DR",
"city": "BRANDON",
"state": "MS",
"postal_code": "390422906",
"telephone_number": "601-278-9985"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2611 JONES AVE",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810042650",
"telephone_number": "719-564-1735"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SCARBOROUGH",
"first_name": "BRADLEY",
"name_prefix": "Mr.",
"credential": "LPTA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-01-14",
"last_updated": "2021-01-14",
"certification_date": "2021-01-14",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "CO",
"license": "CP003218A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pueblo, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.