Most Relevant Information
Provider Data
| NPI Number: | 1003473315 |
| Provider Name: | LORI NICOLE BRADSHER PTA |
| Entity Type: | Individual |
| Taxonomy Code: | 225200000X |
| Specialty: | Physical Therapy Assistant |
| License Number: |
Most Important Dates
| Enumeration Date: | 05/22/2019 |
| Last Updated: | 05/22/2019 |
Provider Practice Location
11200 GOVERNOR MANLY WAY STE 305
RALEIGH
NC
276147383
Practice Location Phone/Fax
| Phone: | 9195629410 |
| Fax: | 9195622948 |
Provider Mailing Location
11200 GOVERNOR MANLY WAY STE 309
RALEIGH
NC
276147375
Provider Mailing Phone/Fax
| Phone: | 9195629410 |
| Fax: | 9195622948 |