MEDICARE: BRADLEY G BILLS PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2634	OK
2	2251S0007X	Sports Physical Therapist	1090439	TX
3	2251X0800X	Orthopedic Physical Therapist	1090439	TX
4	225100000X	Physical Therapist	1090439	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	120487	OTHER		SUPERIOR PROVIDER NUMBER
4	80814T	OTHER	TX	BCBS PROVIDER NUMBER
5	7680464	OTHER		AETNA PROVIDER NUMBER

General Provider Information

NPI Number	:	1073553673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRADLEY G BILLS PT

Provider Business Mailing Address
First Line	:	103 N COLLEGE ST
Second Line	:
City	:	CLARKSVILLE
State	:	TX
Zip	:	75426-2982
Country	:	US
Telephone Number	:	903-428-0090
Fax Number	:	903-428-0093

Provider Business Practice Location Address
First Line	:	103 N COLLEGE ST
Second Line	:
City	:	CLARKSVILLE
State	:	TX
Zip	:	75426-2982
Country	:	US
Telephone Number	:	903-428-0090
Fax Number	:	903-428-0093

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	05/04/2020

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Directions to “ BRADLEY G BILLS PT” Practice Location

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