Provider Demographics
NPI:1962797282
Name:BRADSHAW, RAINE MICHELLE (DPT)
Entity type:Individual
Prefix:DR
First Name:RAINE
Middle Name:MICHELLE
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:RAINE
Other - Middle Name:MICHELLE
Other - Last Name:KAUFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:800 HOSPITAL DR.
Mailing Address - Street 2:PM&R - PT
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-5275
Mailing Address - Country:US
Mailing Address - Phone:573-843-1855
Mailing Address - Fax:
Practice Address - Street 1:800 HOSPITAL DR.
Practice Address - Street 2:PM&R - PT
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-5275
Practice Address - Country:US
Practice Address - Phone:573-843-1855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST-02971225100000X
NV2776225100000X
KS11-04295225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist