MEDICARE: BRAD BILLS PHYSICAL THERAPY SERVICES INC

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

General Provider Information

NPI Number	:	1528682358
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRAD BILLS PHYSICAL THERAPY SERVICES INC

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	:

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	:

Authorized Official
Title or Position	:	MANAGER
Name	:	KANDACE J SMOCK
Credential	:
Telephone Number	:	903-249-5370

Provider Enumeration Date	:	06/08/2020
Last Update Date	:	07/01/2020

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