Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1090439 | TX |
N | 225100000X | Physical Therapist | 2634 | OK |
N | 2251S0007X | Physical Therapist - Sports | 1090439 | TX |
N | 2251X0800X | Physical Therapist - Orthopedic | 1090439 | TX |
NPI | 1073553673 |
---|---|
Provider Name | Bradley G Bills |
First Address | Clarksville, TX 75426-2982 |
Second Address | Clarksville, TX 75426-2982 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 04/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
058539001 | (05) | TX |
100835480A | (05) | OK |
120487 | SUPERIOR PROVIDER NUMBER (01) | |
7680464 | AETNA PROVIDER NUMBER (01) | |
80814T | BCBS PROVIDER NUMBER (01) | TX |