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General NPI Number Information
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NPI Number | 1154767911
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Entity Type | Organization
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Legal Business Name | BRADWELL DIVERSIFIED
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Dates
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Enumeration Date | 05/20/2013
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Last Update Date | 07/16/2013
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Provider Practice Location Address
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Address Line | 27043 BAKER POTTS RD
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City | HARLINGEN
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State | TX
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Zip | 78552-3761
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Country | US
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Telephone | 956-792-4542
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Fax |
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Provider Business Mailing Address
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Address Line | 27043 BAKER POTTS RD
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City | HARLINGEN
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State | TX
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Zip | 78552-3761
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Country | US
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Telephone | 956-792-4542
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. GRACIELA A BRADWELL
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Credential | SLP ASSISTANT
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Telephone | 956-792-4542
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State | NULL
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