Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081S0010X | Sports Medicine | PT-007908 | KY |
N | 213ES0000X | Sports Medicine | PT-007908 | KY |
Y | 225100000X | Physical Therapist | PTL0017143 | CO |
NPI | 1083248462 |
---|---|
Provider Name | Dr. Jordan Nicole Bradfield |
First Address | Kalispell, MT 59903-5718 |
Second Address | Boulder, CO 80301-2364 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2020 |
Last Update Date | 17/09/2020 |