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NPI Code Detail

MEDICARE: MR. LANDON HOPE BRADFORD ATC

MEDICARE: MR. LANDON HOPE BRADFORD ATC
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
12255A2300XAthletic Trainer096.002701IL
22255A2300XAthletic Trainer0370AZ

General Provider Information

NPI Number : 1235142779
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. LANDON HOPE BRADFORD ATC
Provider Business Mailing Address
First Line : 1705 SOUTH SAN FRANCISCO STREET
Second Line : STUDENT ATHLETE HIGH PERFORMANCE CENTER
City : FLAGSTAFF
State : AZ
Zip : 86011
Country : US
Telephone Number : 928-523-5469
Fax Number :
Provider Business Practice Location Address
First Line : 1705 SOUTH SAN FRANCISCO STREET
Second Line : STUDENT ATHLETE HIGH PERFORMANCE CENTER
City : FLAGSTAFF
State : AZ
Zip : 86011
Country : US
Telephone Number : 928-523-5469
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2006
Last Update Date : 01/13/2025

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