Provider Demographics
NPI:1124177126
Name:RADFORD, STEVEN L (DPT)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:L
Last Name:RADFORD
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 1:300 MEADOW BROOK CIR
Mailing Address - Street 2:
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-8349
Mailing Address - Country:US
Mailing Address - Phone:479-524-3378
Mailing Address - Fax:479-524-3370
Practice Address - Street 1:2021 B EAST MAIN
Practice Address - Street 2:
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-5585
Practice Address - Country:US
Practice Address - Phone:479-524-3378
Practice Address - Fax:479-524-3370
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT2680225100000X
CO10535225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5Y149Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER #
AR5C930Medicare ID - Type UnspecifiedGROUP PROVIDER #