BRADLEY J WALLRATH (NPI# 1720329485) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720329485 |
| Entity Type | Individual |
| Full Name | BRADLEY J WALLRATH |
| Credential | PA |
| Practice Address |
10131 Forest Hill Blvd Ste 206 Wellington FL 33414-6109 |
| Mailing Address |
10131 Forest Hill Blvd Ste 230 Wellington FL 33414-6109 |
| Practice Telephone | 5617986600 |
| Practice Fax Number | 5617533328 |
| Mailing Telephone | 5617986600 |
| Mailing Fax Number | 5617533328 |
| Enumeration Date | 2013-03-06 |
| Last Update Date | 2014-08-05 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363A00000X | Physician Assistant | PA9107050 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
PA9107050 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 008416700 | 05 | |
| GA | 003134530A | 05 |
| Street Address |
10131 FOREST HILL BLVD STE 206 |
| City | WELLINGTON |
| State | FL |
| Zip Code | 33414-6109 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669460606 | Wanda Alexandra Danuz | Nurse Practitioner | 10131 Forest Hill Blvd Ste 206, Wellington, FL 33414-6109 | 2005-10-13 |
| 1598238370 | Maxwell A Joffe | Physician Assistant | 10131 Forest Hill Blvd Ste 206, Wellington, FL 33414-6109 | 2019-01-04 |
| 1033434535 | Gavin P Hart | Orthopaedic Surgery | 10131 Forest Hill Blvd Ste 206, Wellington, FL 33414-6109 | 2010-03-29 |
| 1992787147 | Mark A Waeltz | Orthopaedic Surgery | 10131 Forest Hill Blvd Ste 206, Wellington, FL 33414-6109 | 2005-11-15 |
| 1437149358 | Robert A Rochman | Orthopaedic Surgery | 10131 Forest Hill Blvd Ste 206, Wellington, FL 33414-6109 | 2005-10-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932707247 | Juana Maria Gonzales | Home Health | 2766 Penhall Ct, Wellington, FL 33414 | 2020-10-09 |
| 1821601089 | Wellington Rehab and Health Center, LLC | Skilled Nursing Facility | 10330 Nu Vista Ave, Wellington, FL 33414 | 2020-08-27 |
| 1730661158 | Michelle Alexis Anagnostu | Nurse Practitioner | 1447 Medical Park Blvd Suite 406, Wellington, FL 33414 | 2018-09-01 |
| 1932686193 | Borola Inc | Occupational Therapy Assistant | 1985 Canterbury Circle, Wellington, FL 33414 | 2018-07-20 |
| 1841783156 | Kid'z World Advance Inc | Behavioral Analyst | 2400 Wrotham Ter, Wellington, FL 33414 | 2018-06-11 |
| 1134619489 | Devin Michael Scheller | Counselor | 2077 Vinings Circle Apt 1303, Wellington, FL 33414 | 2018-05-12 |
| 1942726617 | Amanda Hardy | Social Worker | 11120 South Way, Suite 1, Wellington, FL 33414 | 2017-08-15 |
| 1467976423 | Dawn Carnegia Blackshear | Nurse Practitioner | 1397 Medical Park Blvd Ste 480, Wellington, FL 33414 | 2017-08-01 |
| 1508390238 | Morgan Mccollum | Speech-Language Pathologist | 2158 Polo Gardens Dr Apt 203, Wellington, FL 33414 | 2017-04-19 |
| 1003369786 | Memite G Charlemagne | Registered Nurse | 184 Berenger Walk, Royal Palm Beach, FL 33414 | 2016-07-28 |
| Find all providers in zip 33414 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992755714 | Kimberly Anne Ifill | Physician Assistant | 10140 Forest Hill Blvd, Suite, Wellington, FL 33414 | 2006-05-11 |
| 1598238370 | Maxwell A Joffe | Physician Assistant | 10131 Forest Hill Blvd Ste 206, Wellington, FL 33414-6109 | 2019-01-04 |
| 1164932257 | Emily Carr | Physician Assistant | 1447 Medical Park Blvd Ste 101, Wellington, FL 33414-3164 | 2017-10-03 |
| 1477099596 | Palm Beach Neurosurgery | Physician Assistant | 3319 State Road 7, Suite 313, Wellington, FL 33449-8094 | 2017-01-12 |
| 1548705163 | Christina L Daniello | Physician Assistant | 3319 State Road 7, Wellington, FL 33449-8094 | 2017-01-05 |
| 1861627952 | Jb Surgical Assistance Inc | Physician Assistant | 8950 Alexandra Cir, Wellington, FL 33414-6438 | 2009-05-19 |
| 1780772749 | Robert F Blake | Physician Assistant | 1447 Medical Park Blvd, Suite #101, Wellington, FL 33414-3164 | 2006-10-11 |
| 1134160757 | Stephanie Carrol | Physician Assistant | 12798 W Forest Hill Blvd, Suite 301a, Wellington, FL 33414-4750 | 2006-06-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811598691 | Monica Nancy Ginocchio | Physician Assistant | 1020 Crosspointe Dr Ste 110, Naples, FL 34110-0918 | 2020-11-06 |
| 1427657055 | Alyson Ryall | Physician Assistant | 480 Ventura Pl, Vero Beach, FL 32963-4262 | 2020-10-24 |
| 1104436476 | Forrest Joseph Steslow | Physician Assistant | 1971 Brandywine Rd Apt 305, West Palm Beach, FL 33409-6800 | 2020-08-03 |
| 1063039576 | Joshua Bras Prewitt | Physician Assistant | 4800 Linton Blvd Ste 201, Delray Beach, FL 33445-6584 | 2020-06-30 |
| 1003443904 | Sheila Rhinehart | Physician Assistant | 981 Tarpon Ave, Sebastian, FL 32958-5147 | 2020-03-23 |
| 1952932493 | Lisel Spieler | Physician Assistant | 1173 Fins Up Ct, Daytona Beach, FL 32124-3719 | 2020-02-03 |
| 1326685991 | Nikolai X Lincavage | Physician Assistant | 29277 Us Highway 19 N # 29277, Clearwater, FL 33761-2102 | 2019-12-03 |
| 1356984686 | Zane K Jude | Physician Assistant | 1775 Linton Lake Dr, Delray Beach, FL 33445-6927 | 2019-10-18 |
| 1720635998 | Jose R Munoz | Physician Assistant | 4801 Esedra Ct Apt 203, Lake Worth, FL 33467-5019 | 2019-08-22 |
| 1811559578 | Sydney Gillen | Physician Assistant | 1222 S Orange Ave Fl 2, Orlando, FL 32806-1215 | 2019-07-02 |
| Find all providers with the same taxonomy | ||||
| City | WELLINGTON |
| Zip Code | 33414 |
Please comment or provide details below to improve the information on BRADLEY J WALLRATH.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.