Provider Demographics
NPI:1689251431
Name:RANKIN, BRADLEY STEVEN (PTA)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:STEVEN
Last Name:RANKIN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 ASPEN HEIGHTS LOOP
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-6713
Mailing Address - Country:US
Mailing Address - Phone:530-746-1081
Mailing Address - Fax:
Practice Address - Street 1:36867 COOK ST STE 103
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-6064
Practice Address - Country:US
Practice Address - Phone:800-489-6905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK169528225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant