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General NPI Number Information
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NPI Number | 1740374164
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Entity Type | Individual
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Provider Name | CLAYTON H. BRAKEVILLE M.S.P.T.
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Gender | Male
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 107 S. DANIELS ST
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City | CARTHAGE
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State | TX
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Zip | 75633
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Country | US
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Telephone | 903-694-9371
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Fax | 903-694-2898
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Provider Business Mailing Address
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Address Line | 107 S. DANIELS ST
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City | CARTHAGE
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State | TX
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Zip | 75633
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Country | US
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Telephone | 903-694-9371
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Fax | 903-694-2898
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1128072
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License Number State | TX
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