Provider Demographics
NPI:1427557693
Name:BRADTKE, GRACE KATHERINE (MS, ATC)
Entity Type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:KATHERINE
Last Name:BRADTKE
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:MISS
Other - First Name:GRACE
Other - Middle Name:KATHERINE
Other - Last Name:GILES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, ATC
Mailing Address - Street 1:2208 MENDOTA DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-3345
Mailing Address - Country:US
Mailing Address - Phone:804-523-0397
Mailing Address - Fax:
Practice Address - Street 1:1115 BOULDERS PKWY STE 110
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23225-4067
Practice Address - Country:US
Practice Address - Phone:804-560-6517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-02
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260027102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer