Organization
SPORTS, BACK & PAIN MANGEMENT CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEON F BRADWAY (PHYSICAL THERAPIST)
(979) 776-2225
Entity
Organization
Contact information
Practice address
2011 #A VILLA MARIA RD, BRYAN, TX 77802-2541
(979) 776-2225
(979) 776-7945
Mailing address
2011 #A VILLA MARIA RD, BRYAN, TX 77802-2541
(979) 776-2225
(979) 776-7945
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
1055085
TX
2251E1300X
Clinical Electrophysiology Physical Therapist
1055085
TX
2251G0304X
Geriatric Physical Therapist
1055085
TX
2251H1300X
Human Factors Physical Therapist
1055085
TX
2251S0007X
Sports Physical Therapist
1055085
TX
2251X0800X
Orthopedic Physical Therapist
Primary
1055085
TX
Other
Enumeration date
10/31/2008
Last updated
10/31/2008
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