Provider Demographics
NPI:1366692188
Name:RADFORD, BRIDGET JONES (PTA)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:JONES
Last Name:RADFORD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8025 DOUBLE DAY DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46216-2016
Mailing Address - Country:US
Mailing Address - Phone:317-543-2649
Mailing Address - Fax:317-543-2684
Practice Address - Street 1:8025 DOUBLE DAY DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46216-2016
Practice Address - Country:US
Practice Address - Phone:317-543-2649
Practice Address - Fax:317-543-2684
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06001109A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant