Provider Demographics
NPI:1518656958
Name:BRADSHAW, ELIZABETH NOELLE
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:NOELLE
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 JEFFERSON DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29020-3337
Mailing Address - Country:US
Mailing Address - Phone:803-669-5296
Mailing Address - Fax:
Practice Address - Street 1:1706 JEFFERSON DAVIS HWY
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020-3337
Practice Address - Country:US
Practice Address - Phone:803-669-5296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7559225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist