Provider Demographics
NPI:1073553673
Name:BILLS, BRADLEY G (PT)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:G
Last Name:BILLS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 N COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75426-2982
Mailing Address - Country:US
Mailing Address - Phone:903-428-0090
Mailing Address - Fax:903-428-0093
Practice Address - Street 1:103 N COLLEGE ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TX
Practice Address - Zip Code:75426-2982
Practice Address - Country:US
Practice Address - Phone:903-428-0090
Practice Address - Fax:903-428-0093
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2634225100000X
TX10904392251S0007X, 2251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100835480AMedicaid
TX058539001Medicaid
120487OtherSUPERIOR PROVIDER NUMBER
TX80814TOtherBCBS PROVIDER NUMBER
7680464OtherAETNA PROVIDER NUMBER