Provider Demographics
NPI:1497845143
Name:BRACEWELL, WILLIAM R (PT ECS DPT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
Last Name:BRACEWELL
Suffix:
Gender:M
Credentials:PT ECS DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:846 S DORA ST
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-5711
Mailing Address - Country:US
Mailing Address - Phone:707-462-9784
Mailing Address - Fax:707-462-9785
Practice Address - Street 1:846 S DORA ST
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-5711
Practice Address - Country:US
Practice Address - Phone:707-462-9784
Practice Address - Fax:707-462-9785
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2024-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA45-4897134OtherEIN