Provider Demographics
NPI:1316996663
Name:BRADFORD, CHRISTINA M (PT)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:M
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CHRISSY
Other - Middle Name:
Other - Last Name:BARRETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2100 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-2758
Mailing Address - Country:US
Mailing Address - Phone:479-698-2525
Mailing Address - Fax:479-968-2538
Practice Address - Street 1:2100 W MAIN ST
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-2758
Practice Address - Country:US
Practice Address - Phone:479-698-2525
Practice Address - Fax:479-968-2538
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2699225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR152948721Medicaid
AR445934001OtherPALMETTO GI DME
AR662725OtherHEALTHLINK
AR5X681OtherBLUE CROSS BLUE SHIELD
ARP00081426OtherPALMETTO GI RAILROAD
AR71085780150OtherQUALCHOICE
AR445934001OtherPALMETTO GI DME