MEDICARE: JEANNE JOKINEN BRADSHAW PT, OCS

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	225100000X	Physical Therapist	6012	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043402159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANNE JOKINEN BRADSHAW PT, OCS

Provider Business Mailing Address
First Line	:	PO BOX 2600
Second Line	:
City	:	BOONE
State	:	NC
Zip	:	28607-2600
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	232 BOONE HEIGHTS DR
Second Line	:	SUITE A
City	:	BOONE
State	:	NC
Zip	:	28607-4926
Country	:	US
Telephone Number	:	828-262-9043
Fax Number	:	828-268-9045

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

Provider Enumeration Date	:	08/13/2007
Last Update Date	:	08/13/2007

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