Provider Demographics
NPI:1235142779
Name:BRADFORD, LANDON HOPE (ATC)
Entity type:Individual
Prefix:MR
First Name:LANDON
Middle Name:HOPE
Last Name:BRADFORD
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 SOUTH SAN FRANCISCO STREET
Mailing Address - Street 2:STUDENT ATHLETE HIGH PERFORMANCE CENTER
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86011
Mailing Address - Country:US
Mailing Address - Phone:928-523-5469
Mailing Address - Fax:
Practice Address - Street 1:1705 SOUTH SAN FRANCISCO STREET
Practice Address - Street 2:STUDENT ATHLETE HIGH PERFORMANCE CENTER
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86011
Practice Address - Country:US
Practice Address - Phone:928-523-5469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096.0027012255A2300X
AZ03702255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer