Individual
JEREMY LYNN BRADFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
794 S COOPER ST STE 102, MEMPHIS, TN 38104-5406
(901) 337-4316
Mailing address
11654 MILLWIND DR, ARLINGTON, TN 38002-5032
(901) 337-4316
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
8123
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00881382
RAILROAD MEDICARE
TN
05
—
07274094
—
MS
05
—
110318002
—
AR
05
—
1512533
—
TN
05
—
3371161
—
TN
01
—
4189661
BCBS
TN
01
—
620819926
BCBS
MS
01
—
620819926
TRICARE
TN
05
—
7187860
—
MS
01
—
9680169
AETNA
TN
Enumeration date
07/08/2008
Last updated
01/31/2022
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