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General NPI Number Information
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NPI Number | 1073758280
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Entity Type | Organization
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Legal Business Name | BRAWLEY PHYSICAL THERAPY
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Dates
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Enumeration Date | 12/03/2008
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Last Update Date | 12/03/2008
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Provider Practice Location Address
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Address Line | 529 E STREET
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City | BRAWLEY
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State | CA
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Zip | 92227
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Country | US
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Telephone | 760-344-9000
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Fax | 760-344-9191
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Provider Business Mailing Address
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Address Line | 1942 PAULA LANE
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City | HOLTVILLE
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State | CA
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Zip | 92250
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Country | US
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Telephone | 760-344-9000
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Fax | 760-344-9191
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Authorized Official
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Title or Position | OWNER
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Name | DOUGLAS D WISDOM
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Credential | PT
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Telephone | 760-344-9000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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