Individual
JEREMY LYNN BRADFORD
Active
Individual
JEREMY LYNN BRADFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
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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