MEDICARE: DAVID BRADLEY TILLEY

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	225200000X	Physical Therapy Assistant	2150398	TX

General Provider Information

NPI Number	:	1407406150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID BRADLEY TILLEY

Provider Business Mailing Address
First Line	:	811 CROSS TIMBERS DR
Second Line	:
City	:	KELLER
State	:	TX
Zip	:	76248-3842
Country	:	US
Telephone Number	:	804-307-0125
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 COUNTRY BROOK DR APT 2110
Second Line	:
City	:	KELLER
State	:	TX
Zip	:	76248-2135
Country	:	US
Telephone Number	:	817-337-3082
Fax Number	:

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

Provider Enumeration Date	:	09/15/2019
Last Update Date	:	09/15/2019

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Directions to “ DAVID BRADLEY TILLEY ” Practice Location

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