Individual
TIMOTHY BRADFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5433 VALLEYSIDE LN, SAINT LOUIS, MO 63128-3747
(314) 744-0373
Mailing address
5433 VALLEYSIDE LN, SAINT LOUIS, MO 63128-3747
(314) 744-0373
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160007758
IL
Other
Enumeration date
12/03/2021
Last updated
12/03/2021
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