Provider Demographics
NPI:1740812973
Name:BRADSHAW, ANNSLEY AARON (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:ANNSLEY
Middle Name:AARON
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:MISS
Other - First Name:ANNSLEY
Other - Middle Name:ALYSSA
Other - Last Name:AARON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10509 KEYSBURG CT
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-7786
Mailing Address - Country:US
Mailing Address - Phone:318-265-0826
Mailing Address - Fax:
Practice Address - Street 1:4900 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71112-4521
Practice Address - Country:US
Practice Address - Phone:318-841-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA09896225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist