Healthcare Provider Details

I. General information

NPI: 1730553959
Provider Name (Legal Business Name): BRADLEY LASSITER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2015
Last Update Date: 11/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 LEGACY DR SUITE 360
PLANO TX
75024-3100
US

IV. Provider business mailing address

5000 LEGACY DR SUITE 360
PLANO TX
75024-3100
US

V. Phone/Fax

Practice location:
  • Phone: 972-248-2441
  • Fax: 972-248-0773
Mailing address:
  • Phone: 972-248-2441
  • Fax: 972-248-0773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: