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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