Provider Demographics
NPI:1235142779
Name:BRADFORD, LANDON HOPE (ATC)
Entity Type:Individual
Prefix:MR
First Name:LANDON
Middle Name:HOPE
Last Name:BRADFORD
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:565 N CHERRY AVE
Mailing Address - Street 2:LOWELL-STEVENS FOOTBALL FACILITY
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85721-0096
Mailing Address - Country:US
Mailing Address - Phone:520-621-5964
Mailing Address - Fax:
Practice Address - Street 1:565 N CHERRY AVE
Practice Address - Street 2:LOWELL-STEVENS FOOTBALL FACILITY
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85721-0096
Practice Address - Country:US
Practice Address - Phone:520-621-5964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ03702255A2300X
IL096.0027012255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer