Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant |
NPI | 1003352386 |
---|---|
Provider Name | Bradly Bechel |
First Address | Swansea, IL 62226-5972 |
Second Address | Swansea, IL 62226-5972 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2017 |
Last Update Date | 11/01/2017 |