Individual
KATIE MARIE BRADSHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
4110 51ST AVE S, FARGO, ND 58104-7776
(701) 364-4222
Mailing address
PO BOX 6001, FARGO, ND 58108-6001
(701) 364-6800
(701) 364-6828
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1617
ND
225100000X
Physical Therapist
7562
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1114048378
—
MN
05
—
55992
—
ND
Enumeration date
04/03/2007
Last updated
12/20/2016
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