Provider Demographics
NPI:1942324900
Name:BRADBURY, MARIAN CLAIR (PT)
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:CLAIR
Last Name:BRADBURY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7219 VIA VERDE
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-2790
Mailing Address - Country:US
Mailing Address - Phone:505-424-9713
Mailing Address - Fax:
Practice Address - Street 1:706-D LA JOYA
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-2877
Practice Address - Country:US
Practice Address - Phone:505-753-6550
Practice Address - Fax:505-753-1219
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM31512251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic