Basic Information
Provider Information
NPI: 1255390449
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HELMS
FirstName: BRADLEY
MiddleName: A
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8170 33RD AVE S
Address2: MS 21110Q
City: BLOOMINGTON
State: MN
PostalCode: 554254516
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 295 PHALEN BLVD
Address2:  
City: SAINT PAUL
State: MN
PostalCode: 551302400
CountryCode: US
TelephoneNumber: 6514956200
FaxNumber: 9528839669
Other Information
ProviderEnumerationDate: 03/17/2006
LastUpdateDate: 11/11/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/11/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208100000X42187MNY Allopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation 

No ID Information.


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