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1346905841
BRADY SUPRIADI
FONTANA, CA
NPI
1346905841
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
225100000X Physical Therapist
(Licence: CA PT301113)
Enumeration Date
2021-11-01
Last Update Date
2021-11-01
Business Address
BRADY SUPRIADI DPT
8545 SIERRA AVE
FONTANA, CA 92335-3868
Phone number: 909-365-3557
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Mailing Address
BRADY SUPRIADI DPT
8545 SIERRA AVE
FONTANA, CA 92335-3868
Phone number: 909-365-3557
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