Provider Demographics
NPI:1104936541
Name:MARTIN, BRADFORD FRANCIS (PT)
Entity type:Individual
Prefix:DR
First Name:BRADFORD
Middle Name:FRANCIS
Last Name:MARTIN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12961 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-4158
Mailing Address - Country:US
Mailing Address - Phone:408-255-9641
Mailing Address - Fax:408-255-9641
Practice Address - Street 1:12961 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-4158
Practice Address - Country:US
Practice Address - Phone:408-255-9641
Practice Address - Fax:408-255-9641
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X, 2251G0304X, 2251S0007X
CA133972251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
Not Answered2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA13397OtherCA PT LICENSE NUMBAR
CA0PT133970Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER