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General NPI Number Information
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NPI Number | 1316437940
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Entity Type | Individual
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Provider Name | PATRICK R BRAYALL
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Gender | Male
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Dates
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Enumeration Date | 05/18/2018
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Last Update Date | 02/11/2019
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Provider Practice Location Address
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Address Line | 126 N 2ND ST
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City | STERLING
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State | CO
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Zip | 80751
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Country | US
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Telephone | 970-425-7272
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Fax | 970-541-0099
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Provider Business Mailing Address
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Address Line | 15 APEX DR
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City | HIGHLAND
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State | IL
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Zip | 62249-1282
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Country | US
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Telephone | 618-651-0444
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Fax | 618-654-5439
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | PT5111
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 0015948
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License Number State | CO
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