Provider Demographics
NPI:1124204508
Name:BRADFORD PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:BRADFORD PHYSICAL THERAPY PC
Other - Org Name:ASCENT THERAPY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADFORD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:303-978-9200
Mailing Address - Street 1:9116 W BOWLES AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-3477
Mailing Address - Country:US
Mailing Address - Phone:303-978-9200
Mailing Address - Fax:303-973-4886
Practice Address - Street 1:9116 W BOWLES AVE STE 10
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-3477
Practice Address - Country:US
Practice Address - Phone:303-978-9200
Practice Address - Fax:303-973-4886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC25683OtherMEDICARE PART B
COC25683OtherMEDICARE PART B