MEDICARE: LAURA R BRADFORD LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MA42290	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C2816	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1285846204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA R BRADFORD LMT

Provider Business Mailing Address
First Line	:	222 SE WENONA AVE
Second Line	:
City	:	OCALA
State	:	FL
Zip	:	34471-2219
Country	:	US
Telephone Number	:	352-875-3372
Fax Number	:	352-840-7119

Provider Business Practice Location Address
First Line	:	1107 E SILVER SPRINGS BLVD
Second Line	:	SUITE 4
City	:	OCALA
State	:	FL
Zip	:	34470-6758
Country	:	US
Telephone Number	:	352-840-7119
Fax Number	:	352-840-7119

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	07/08/2007

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Directions to “ LAURA R BRADFORD LMT” Practice Location

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