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NPI Code Detail

MEDICARE: BROOK BRADFORD CORBITT PT

MEDICARE: BROOK BRADFORD CORBITT 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
1225100000XPhysical Therapist2522NV

General Provider Information

NPI Number : 1235435710
Entity Type Code : Individual
Provider Name (Legal Business Name) : BROOK BRADFORD CORBITT PT
Provider Business Mailing Address
First Line : 8925 W RUSSELL RD
Second Line : # 140
City : LAS VEGAS
State : NV
Zip : 89148-1219
Country : US
Telephone Number : 702-914-6787
Fax Number : 702-914-6885
Provider Business Practice Location Address
First Line : 3831 W CHARLESTON BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-1859
Country : US
Telephone Number : 702-876-1733
Fax Number : 702-878-2018
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/01/2011
Last Update Date : 02/01/2011

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Directions to “ BROOK BRADFORD CORBITT PT” Practice Location

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