Provider Demographics
NPI:1952759961
Name:BRADFORD, JADE MICHAEL (DPT)
Entity Type:Individual
Prefix:MR
First Name:JADE
Middle Name:MICHAEL
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 1:6022 SW 48TH AVE
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-7504
Mailing Address - Country:US
Mailing Address - Phone:806-355-5244
Mailing Address - Fax:806-353-6151
Practice Address - Street 1:6022 SW 48TH AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-7504
Practice Address - Country:US
Practice Address - Phone:806-355-5244
Practice Address - Fax:806-353-6151
Is Sole Proprietor?:No
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1275636225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist