Individual provider · NPI-1

Bradley V Bluestone, ATC

Specialist/Technologist, Athletic Trainer · Louisville, KY

NPI number1619088861
StatusActive
Last updated in NPPESDec 6, 2012

Details

NPI
1619088861
Entity type
Individual (NPI-1)
Name
Mr. Bradley V Bluestone
Credential
ATC
Sex
Male
Sole proprietor
No
Enumeration date
Aug 31, 2006
Last updated
Dec 6, 2012

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
2255A2300X Specialist/Technologist, Athletic TrainerAT142KYYes

Practice location

2001 Newburg Rd
Louisville, KY 40205-1863

Phone 502-272-8379

Mailing address

10305 Cooperwood Ct
Louisville, KY 40229-2276

Phone 502-969-4310

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