Active NPI
Mark Winter Bradley, L.M.T.
- Specialist
- West Melbourne, FL
National Provider Identifier
1356408116
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- MA 4120
- Practice address
- 756 Preakness Dr
West Melbourne, FL 32904-7310 - Phone
- (321) 749-1924
- NPI assigned
- Jan 2, 2007
- Last updated
- Jul 8, 2007
- 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 |
|---|---|---|---|---|
| Specialist | 174400000X | MA 4120 | FL | Primary |
Addresses
Primary practice location
756 Preakness Dr
West Melbourne, FL 32904-7310
Mailing address
756 Preakness Dr
West Melbourne, FL 32904-7310
Phone (321) 749-1924
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 |
|---|---|---|---|
| MA 4120 | FL | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167696000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1356408116",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "756 PREAKNESS DR",
"city": "WEST MELBOURNE",
"state": "FL",
"postal_code": "329047310",
"telephone_number": "321-749-1924"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "756 PREAKNESS DR",
"city": "WEST MELBOURNE",
"state": "FL",
"postal_code": "329047310",
"telephone_number": "321-749-1924"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRADLEY",
"first_name": "MARK",
"middle_name": "WINTER",
"credential": "L.M.T.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "FL",
"license": "MA 4120",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Melbourne, FL
- Bluebird Care Physicians LLC
- Marina Denali Blunk
- Gerald Bonilla
- Prodromos Gordon Borboroglu, M.D.
- Bradley J E Clow D C P a (Clow Chiropractic Office)
- Kimberly Ann Bray, BCBA
- Bridge the Gap Speech Language Services LLC
- Kristen Marie Brong, OTR/L
- Brookdale Senior Living Communities, Inc. (Brookdale West Melbourne)
- Brookdale Senior Living Communities, Inc. (Brookdale West Melbourne)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.