Provider Demographics
NPI:1124462643
Name:LUNSFORD, BRADLEY VICTOR (LMT)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:VICTOR
Last Name:LUNSFORD
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1619 HERMOSA DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-5626
Mailing Address - Country:US
Mailing Address - Phone:505-803-7231
Mailing Address - Fax:
Practice Address - Street 1:3807 ATRISCO DR NW
Practice Address - Street 2:SUITE 1A
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-4907
Practice Address - Country:US
Practice Address - Phone:505-615-3487
Practice Address - Fax:505-352-8966
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-26
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM7555225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist