Healthcare Provider Details

I. General information

NPI: 1811083223
Provider Name (Legal Business Name): NATALIE ROSE BRADFORD PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

792 COLLEGE PARKWAY, SUITE 201
COLCHESTER VT
05446
US

IV. Provider business mailing address

299 CAMP KINIYA ROAD
COLCHESTER VT
05446
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-7910
  • Fax: 802-847-6987
Mailing address:
  • Phone: 802-893-8715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number040-0003284
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: