Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | ||
N | 2251N0400X | Physical Therapist - Neurology |
NPI | 1497845143 |
---|---|
Provider Name | William R Bracewell |
First Address | Ukiah, CA 95482-5711 |
Second Address | Ukiah, CA 95482-5711 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 10/11/2017 |