Individual
CLAYTON H. BRAKEVILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.S.P.T.
Contact information
Practice address
107 S. DANIELS ST, CARTHAGE, TX 75633
(903) 694-9371
(903) 694-2898
Mailing address
107 S. DANIELS ST, CARTHAGE, TX 75633
(903) 694-9371
(903) 694-2898
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1128072
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
83356T
BLUE CROSS PROVIDER #
TX
Enumeration date
10/02/2006
Last updated
07/09/2007
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