Provider Demographics
NPI:1023385044
Name:BRADFORD, KATIE BETH (PT)
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:BETH
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 VILLAGE SQ APT 300
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VIEW
Mailing Address - State:TN
Mailing Address - Zip Code:37146-7190
Mailing Address - Country:US
Mailing Address - Phone:615-268-1259
Mailing Address - Fax:
Practice Address - Street 1:176 VILLAGE SQ APT 300
Practice Address - Street 2:
Practice Address - City:PLEASANT VIEW
Practice Address - State:TN
Practice Address - Zip Code:37146-7190
Practice Address - Country:US
Practice Address - Phone:615-268-1259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-18
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000004702225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist