Provider Demographics
NPI:1164202552
Name:BRADFORD, BRIANNA SHANTE (LMT)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:SHANTE
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28895 LORAIN RD STE 200
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-4042
Mailing Address - Country:US
Mailing Address - Phone:440-734-4084
Mailing Address - Fax:440-734-4184
Practice Address - Street 1:5 SEVERANCE CIR
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-1566
Practice Address - Country:US
Practice Address - Phone:216-721-4955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33024124225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist