Healthcare Provider Details

I. General information

NPI: 1902218613
Provider Name (Legal Business Name): COURTNEY SMITH-BRADLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2014
Last Update Date: 05/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8855 VALLEY RANCH PKWY W
IRVING TX
75063-4630
US

IV. Provider business mailing address

501 HIGHLAND DR APT 711
LEWISVILLE TX
75067-4105
US

V. Phone/Fax

Practice location:
  • Phone: 469-619-0847
  • Fax:
Mailing address:
  • Phone: 817-929-7244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1157307
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: