Provider Demographics
NPI:1992151294
Name:AXMAKER, BRADEE ANN (DPT)
Entity type:Individual
Prefix:
First Name:BRADEE
Middle Name:ANN
Last Name:AXMAKER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:BRADEE
Other - Middle Name:ANN
Other - Last Name:LUHR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:65 E WADSWORTH PARK DR STE 230
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-8096
Mailing Address - Country:US
Mailing Address - Phone:385-308-8034
Mailing Address - Fax:
Practice Address - Street 1:28300 GROUSE ROAD
Practice Address - Street 2:
Practice Address - City:SMITHWICK
Practice Address - State:SD
Practice Address - Zip Code:57782-5778
Practice Address - Country:US
Practice Address - Phone:907-518-0575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-05
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2270225100000X
NM2023-0016225100000X
AK27222251P0200X, 225100000X
SD2608225100000X
IL070027459225100000X
CA304118225100000X
ID8597225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics