Provider Demographics
NPI:1285846204
Name:BRADFORD, LAURA R (LMT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:R
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 1:222 SE WENONA AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-2219
Mailing Address - Country:US
Mailing Address - Phone:352-875-3372
Mailing Address - Fax:352-840-7119
Practice Address - Street 1:1107 E SILVER SPRINGS BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-6758
Practice Address - Country:US
Practice Address - Phone:352-840-7119
Practice Address - Fax:352-840-7119
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA42290225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC2816OtherBLUE CROSS BLUE SHIELD