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General NPI Number Information
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NPI Number | 1992151294
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Entity Type | Individual
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Provider Name | BRADEE ANN AXMAKER DPT
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Gender | Female
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Dates
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Enumeration Date | 05/05/2016
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Last Update Date | 06/15/2023
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Provider Practice Location Address
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Address Line | 28300 GROUSE ROAD
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City | SMITHWICK
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State | SD
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Zip | 57782-5778
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Country | US
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Telephone | 907-518-0575
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Fax |
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Provider Business Mailing Address
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Address Line | 65 E WADSWORTH PARK DR STE 230
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City | DRAPER
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State | UT
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Zip | 84020-8096
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Country | US
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Telephone | 385-308-8034
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2270
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2023-0016
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 2722
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License Number State | AK
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Taxonomy #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2608
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License Number State | SD
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Taxonomy #5
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070027459
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License Number State | IL
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Taxonomy #6
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 304118
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License Number State | CA
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Taxonomy #7
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2722
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License Number State | AK
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Taxonomy #8
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 8597
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License Number State | ID
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