Individual
PHILLIP BRADLEY TIMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1205 N RAUL LONGORIA RD, SUITE I, SAN JUAN, TX 78589-3720
(956) 782-5800
(956) 782-5802
Mailing address
1205 N RAUL LONGORIA RD, SUITE I, SAN JUAN, TX 78589-3720
(956) 782-5800
(956) 782-5802
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2060712
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2060712
STATE LICENSE
TX
Enumeration date
01/17/2008
Last updated
01/17/2008
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