1053432518 NPI number — ASHLEY NATIONS BRADFORD PT, DPT

Table of content: ASHLEY NATIONS BRADFORD PT, DPT (NPI 1053432518)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053432518 NPI number — ASHLEY NATIONS BRADFORD PT, DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRADFORD
Provider First Name:
ASHLEY
Provider Middle Name:
NATIONS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NATIONS
Provider Other First Name:
ASHLEY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1053432518
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3045 KATE BOND RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BARTLETT
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38133-4004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-937-3200
Provider Business Mailing Address Fax Number:
901-383-1738

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3045 KATE BOND RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARTLETT
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38133-4004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-937-3200
Provider Business Practice Location Address Fax Number:
901-383-1738
Provider Enumeration Date:
04/03/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  6043 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)