Basic Information
| Provider Information | |||||||||
| NPI: | 1003800327 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRADSHAW | ||||||||
| FirstName: | BRIAN | ||||||||
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| Credential: | MS, ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | TOWSON UNIVERSITY DEPT OF ATHLETICS | ||||||||
| Address2: | 8000 YORK ROAD | ||||||||
| City: | TOWSON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212520001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107045501 | ||||||||
| FaxNumber: | 4107042727 | ||||||||
| Practice Location | |||||||||
| Address1: | TOWSON UNIVERSITY DEPT OF ATHLETICS | ||||||||
| Address2: | 8000 YORK ROAD | ||||||||
| City: | TOWSON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212520001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107045501 | ||||||||
| FaxNumber: | 4107042727 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.