Healthcare Provider Details

I. General information

NPI: 1639243405
Provider Name (Legal Business Name): BRADFORD A BETTIS PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 08/18/2020
Certification Date: 08/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COMANCHE PHYSICAL THERAPY SERVICES INC 400 SOUTH HOUSTON
DE LEON TX
76444
US

IV. Provider business mailing address

PO BOX 130
DE LEON TX
76444-0130
US

V. Phone/Fax

Practice location:
  • Phone: 254-893-2015
  • Fax: 254-893-2014
Mailing address:
  • Phone: 254-967-2723
  • Fax: 254-893-2014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1075323
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: