Provider Demographics
NPI:1013346378
Name:BRADFORD, BRANDY
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:BRADFORD
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 1:9700 W SUNSET RD
Mailing Address - Street 2:APT 2052
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-4794
Mailing Address - Country:US
Mailing Address - Phone:702-330-6624
Mailing Address - Fax:702-432-6464
Practice Address - Street 1:9700 W SUNSET RD
Practice Address - Street 2:APT 2052
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-4794
Practice Address - Country:US
Practice Address - Phone:702-330-6624
Practice Address - Fax:702-432-6464
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner