Provider Demographics
NPI:1679269054
Name:LATCHFORD, BRADLEY OSCEOLA
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:OSCEOLA
Last Name:LATCHFORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2272 WABASH TRL
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-8370
Mailing Address - Country:US
Mailing Address - Phone:954-661-7990
Mailing Address - Fax:
Practice Address - Street 1:2272 WABASH TRL
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-8370
Practice Address - Country:US
Practice Address - Phone:954-661-7990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer