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General NPI Number Information
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NPI Number | 1912238973
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Entity Type | Individual
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Provider Name | RONALD DAVID BRACKETT PT
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Gender | Male
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Dates
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Enumeration Date | 01/14/2010
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Last Update Date | 10/10/2017
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Provider Practice Location Address
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Address Line | 313 MANUFACTURERS RD STE 215
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City | CHATTANOOGA
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State | TN
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Zip | 37405-3337
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Country | US
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Telephone | 423-254-5461
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Fax | 800-385-7439
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Provider Business Mailing Address
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Address Line | 501 FOREST LN STE A
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City | CLEMSON
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State | SC
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Zip | 29631-2621
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Country | US
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Telephone | 864-722-0335
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Fax | 800-305-7112
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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 | 6273
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License Number State | TN
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