Provider Demographics
NPI:1811257579
Name:BRADFORD, THOMAS EDWARD (DPT)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:EDWARD
Last Name:BRADFORD
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2066 RED WAGON RD
Mailing Address - Street 2:
Mailing Address - City:TRASKWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72167-8517
Mailing Address - Country:US
Mailing Address - Phone:501-337-6800
Mailing Address - Fax:
Practice Address - Street 1:2066 RED WAGON RD
Practice Address - Street 2:
Practice Address - City:TRASKWOOD
Practice Address - State:AR
Practice Address - Zip Code:72167-8517
Practice Address - Country:US
Practice Address - Phone:501-337-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-29
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1285029225100000X
ARPT 3495225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist