Provider Demographics
NPI:1407868748
Name:BRAZOS PHYSICAL REHABILITATION, LLC
Entity Type:Organization
Organization Name:BRAZOS PHYSICAL REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:BECHTEL
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MS
Authorized Official - Phone:979-877-0871
Mailing Address - Street 1:511 6TH ST
Mailing Address - Street 2:
Mailing Address - City:SEALY
Mailing Address - State:TX
Mailing Address - Zip Code:77474-2629
Mailing Address - Country:US
Mailing Address - Phone:979-877-0871
Mailing Address - Fax:979-877-0582
Practice Address - Street 1:511 6TH ST
Practice Address - Street 2:
Practice Address - City:SEALY
Practice Address - State:TX
Practice Address - Zip Code:77474-2629
Practice Address - Country:US
Practice Address - Phone:979-877-0871
Practice Address - Fax:979-877-0582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0738WMedicare ID - Type Unspecified