Provider Demographics
NPI:1821522350
Name:BRADSHAW, AMARI (ATC)
Entity Type:Individual
Prefix:
First Name:AMARI
Middle Name:
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 PARKER ST
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136-3810
Mailing Address - Country:US
Mailing Address - Phone:857-266-0918
Mailing Address - Fax:
Practice Address - Street 1:11 PARKER ST
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136-3810
Practice Address - Country:US
Practice Address - Phone:857-266-0918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer