Provider Demographics
NPI:1699228973
Name:VESTAL, BRAD
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:
Last Name:VESTAL
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 1:900 8TH ST
Mailing Address - Street 2:STE 520
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-6801
Mailing Address - Country:US
Mailing Address - Phone:940-228-4870
Mailing Address - Fax:940-228-4763
Practice Address - Street 1:5201 BELLAIRE BLVD
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-3901
Practice Address - Country:US
Practice Address - Phone:713-666-1704
Practice Address - Fax:713-666-1184
Is Sole Proprietor?:No
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80341237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist