Provider Demographics
NPI:1447509559
Name:BRADFORD, BETHANY RUTH (DPT)
Entity type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:RUTH
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3110 REYNOLDS RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-9331
Mailing Address - Country:US
Mailing Address - Phone:517-945-1815
Mailing Address - Fax:
Practice Address - Street 1:2111 WILDWOOD AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-4048
Practice Address - Country:US
Practice Address - Phone:517-745-5878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501016026225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist