Provider Demographics
NPI:1609277367
Name:POWER, BRADLEY WILLIAM
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:WILLIAM
Last Name:POWER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 W BETHEL RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-4473
Mailing Address - Country:US
Mailing Address - Phone:972-304-9100
Mailing Address - Fax:972-304-9048
Practice Address - Street 1:413 W BETHEL RD
Practice Address - Street 2:SUITE 400
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-4473
Practice Address - Country:US
Practice Address - Phone:972-304-9100
Practice Address - Fax:972-304-9048
Is Sole Proprietor?:No
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1248793225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist