Provider Demographics
NPI:1780779215
Name:CARTHAGE PHYSICAL THERAPY, PLLC
Entity type:Organization
Organization Name:CARTHAGE PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLAYTON
Authorized Official - Middle Name:H
Authorized Official - Last Name:BRAKEVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:903-694-9371
Mailing Address - Street 1:107 S. DANIELS ST
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75633
Mailing Address - Country:US
Mailing Address - Phone:903-694-9371
Mailing Address - Fax:903-694-2898
Practice Address - Street 1:107 S. DANIELS ST
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:TX
Practice Address - Zip Code:75633
Practice Address - Country:US
Practice Address - Phone:903-694-9371
Practice Address - Fax:903-694-2898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0071DLOtherBLUE CROSS GROUP #
TX0071DLOtherBLUE CROSS GROUP #