Healthcare Provider Details

I. General information

NPI: 1801706395
Provider Name (Legal Business Name): MEGAN BRADFORD MAT, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 FAIRMOUNT ST
WICHITA KS
67260-0001
US

IV. Provider business mailing address

1845 FAIRMOUNT ST
WICHITA KS
67260-0001
US

V. Phone/Fax

Practice location:
  • Phone: 316-978-3251
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number24-01927
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: