Provider Demographics
NPI:1679130306
Name:BRADFORD, AARON MICHAEL (PT, DPT)
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:MICHAEL
Last Name:BRADFORD
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8787 LEGACY DR APT 1176
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-2515
Mailing Address - Country:US
Mailing Address - Phone:214-803-2798
Mailing Address - Fax:
Practice Address - Street 1:5236 W UNIVERSITY DR STE 3500
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-8122
Practice Address - Country:US
Practice Address - Phone:469-952-5082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
TX3129342225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist