Organization
ACTION SPORTS MEDICINE AND PHYSICAL THERAPY
Active
Organization
ACTION SPORTS MEDICINE AND PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES BRADLEY NICHOLLS PHYSICAL THERAPIST (THERAPIST IN CHARGE)
(325) 676-5633
Entity
Organization
Contact information
Practice address
1749 PINE ST, ABILENE, TX 79601-3043
(325) 676-5633
(325) 676-8831
Mailing address
1749 PINE ST, ABILENE, TX 79601-3043
(325) 676-5633
(325) 676-8831
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1-7925-9
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0045KX
BLUE CROSS BLUE SHIELD
TX
05
—
1706194-01
—
TX
Enumeration date
03/13/2007
Last updated
06/16/2008
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