Individual provider Active NPI

Elissa Claire Held Bradford, MPT

  • Physical Therapist
  • Saint Louis, MO
National Provider Identifier
1033299128
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2002003650 Issued in MO
Practice address
11433 Olde Cabin Rd
Saint Louis, MO 63141-7136
Phone
(314) 432-4080
NPI assigned
Oct 16, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 2002003650 MO Primary

Addresses

Primary practice location

11433 Olde Cabin Rd
Saint Louis, MO 63141-7136

Mailing address

9049 Rosemary Ave
Saint Louis, MO 63123-4615
Phone (314) 638-3998

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071012000019 MO Practitioner - Physical Therapist in Private Practice 7012003619 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
SSM Health Care Group CurrentSince Jul 1, 2022 Accepting new patients
SSM Health Care Group CurrentSince Jul 1, 2022 Accepting new patients
St. John's Mercy Therapy Services LLC Past Accepting new patients
St. John's Mercy Therapy Services LLC Physical Therapist Past Accepting new patients

Locations

3635 Vista Ave
Saint Louis, MO 63110
Phone (314) 577-8022

10101 Woodfield Ln
Saint Louis, MO 63132
Phone (608) 280-4647

3691 Rutger St
Fl Prov
Saint Louis, MO 63110

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1033299128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9049 ROSEMARY AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631234615",
            "telephone_number": "314-638-3998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11433 OLDE CABIN RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631417136",
            "telephone_number": "314-432-4080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HELD BRADFORD",
        "first_name": "ELISSA",
        "middle_name": "CLAIRE",
        "name_prefix": "Ms.",
        "credential": "MPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MO",
            "license": "2002003650",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.