Provider Demographics
NPI:1821720913
Name:BATES, BRADFORD ARNETT (LICENSED MT)
Entity Type:Individual
Prefix:MR
First Name:BRADFORD
Middle Name:ARNETT
Last Name:BATES
Suffix:
Gender:M
Credentials:LICENSED MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 TRAVIS ST.
Mailing Address - Street 2:APT. 4427
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002
Mailing Address - Country:US
Mailing Address - Phone:832-236-4223
Mailing Address - Fax:
Practice Address - Street 1:817 MILAM ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-5304
Practice Address - Country:US
Practice Address - Phone:713-223-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-27
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT128914225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist