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NPI Code Detail

MEDICARE: BRADLEY AUSTIN TIPPIN DPT

MEDICARE:   BRADLEY AUSTIN TIPPIN  DPT
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 Therapist1333813TX

General Provider Information

NPI Number : 1255959730
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRADLEY AUSTIN TIPPIN DPT
Provider Business Mailing Address
First Line : PO BOX 2650
Second Line :
City : COPPELL
State : TX
Zip : 75019-8607
Country : US
Telephone Number : 972-724-2400
Fax Number : 972-724-2495
Provider Business Practice Location Address
First Line : 413 W BETHEL RD STE 400
Second Line :
City : COPPELL
State : TX
Zip : 75019-4477
Country : US
Telephone Number : 972-304-9100
Fax Number : 972-304-9048
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2020
Last Update Date : 08/06/2020

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Directions to “ BRADLEY AUSTIN TIPPIN DPT” Practice Location

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