Provider Demographics
NPI:1841559317
Name:ENDRES, BRAD (ATC,LAT,CSCS)
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:
Last Name:ENDRES
Suffix:
Gender:M
Credentials:ATC,LAT,CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 S FM 373
Mailing Address - Street 2:
Mailing Address - City:MUENSTER
Mailing Address - State:TX
Mailing Address - Zip Code:76252-4731
Mailing Address - Country:US
Mailing Address - Phone:940-768-9898
Mailing Address - Fax:
Practice Address - Street 1:616 S FM 373
Practice Address - Street 2:
Practice Address - City:MUENSTER
Practice Address - State:TX
Practice Address - Zip Code:76252-4731
Practice Address - Country:US
Practice Address - Phone:940-768-9898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-03
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT51012255A2300X
20000066232255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer