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General NPI Number Information
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NPI Number | 1235637034
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Entity Type | Individual
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Provider Name | BRIANNA MARIE BRADSHAW ATC
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Gender | Female
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Dates
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Enumeration Date | 01/26/2018
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Last Update Date | 01/26/2018
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Provider Practice Location Address
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Address Line | 601 E BELT LINE RD
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City | DESOTO
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State | TX
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Zip | 75115-5103
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Country | US
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Telephone | 972-223-0690
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Fax | 972-223-0690
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Provider Business Mailing Address
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Address Line | 2403 N WASHINGTON AVE APT 221
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City | DALLAS
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State | TX
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Zip | 75204-3767
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Country | US
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Telephone | 678-467-4257
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT6810
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License Number State | TX
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