Provider Demographics
NPI:1164301842
Name:BRADFORD, LORIE FERGUSON (PT)
Entity type:Individual
Prefix:
First Name:LORIE
Middle Name:FERGUSON
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 NARROWS PKWY STE D
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-8649
Mailing Address - Country:US
Mailing Address - Phone:205-624-2436
Mailing Address - Fax:205-624-2439
Practice Address - Street 1:3532 VANN RD STE 102
Practice Address - Street 2:
Practice Address - City:TRUSSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35235-3263
Practice Address - Country:US
Practice Address - Phone:205-624-2436
Practice Address - Fax:205-624-2439
Is Sole Proprietor?:No
Enumeration Date:2025-08-28
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH4957225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist