Sports, Back & Pain Mangement Clinic

Primary specialty

Orthopedic Physical TherapistTaxonomy code 2251X0800X

License

1055085 Issued in TX

Legal business name

SPORTS, BACK & PAIN MANGEMENT CLINIC

Practice address

2011 #A Villa Maria Rd
Bryan, TX 77802-2541

Phone

(979) 776-2225

Fax

(979) 776-7945

NPI assigned

Oct 31, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Leon F BradwayNPI 1932179306

Title

Physical Therapist

Phone

(979) 776-2225

Specialties & licenses 6

Addresses

Locations

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Leon F. Bradway III, PHYSICIAL THERAPIST

  • Physical Therapist
  • College Station, TX
  • NPI 1932179306
  NPD Authorized official
• Huy Q Nguyen, PTA

  • Physical Therapy Assistant
  • Bryan, TX
  • NPI 1962098418
  NPD
• Suzanne D Black, M.D.

  • Family Medicine Physician
  • Bryan, TX
  • NPI 1720082167
  NPD (past)
• Paul V Bonarrigo, LPT, PC

  • Specialist
  • Bryan, TX
  • NPI 1881760205
  NPD (past)
• Katie Marie Davenport, PT, DPT

  • Physical Therapist
  • Bryan, TX
  • NPI 1457805707
  NPD (past)
• Sarah Walton

  • Physical Therapist
  • Paris, TX
  • NPI 1275052011
  NPD (past)
• Tyler Wilson

  • Physical Therapist
  • Bryan, TX
  • NPI 1639947666
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1225411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1225411200000",
    "number": "1275786469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2011 #A VILLA MARIA RD",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "778022541",
            "telephone_number": "979-776-2225",
            "fax_number": "979-776-7945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2011 #A VILLA MARIA RD",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "778022541",
            "telephone_number": "979-776-2225",
            "fax_number": "979-776-7945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPORTS, BACK & PAIN MANGEMENT CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-31",
        "last_updated": "2008-10-31",
        "status": "A",
        "authorized_official_last_name": "BRADWAY",
        "authorized_official_first_name": "LEON",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "979-776-2225"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1055085",
            "primary": false
        },
        {
            "code": "2251E1300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist, Electrophysiology, Clinical",
            "state": "TX",
            "license": "1055085",
            "primary": false
        },
        {
            "code": "2251G0304X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist, Geriatrics",
            "state": "TX",
            "license": "1055085",
            "primary": false
        },
        {
            "code": "2251H1300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist, Human Factors",
            "state": "TX",
            "license": "1055085",
            "primary": false
        },
        {
            "code": "2251S0007X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist, Sports",
            "state": "TX",
            "license": "1055085",
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist, Orthopedic",
            "state": "TX",
            "license": "1055085",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Homa Arbab Spencer, PHARMD
• Kyle Spencer, LMFT
• Scott Edward Spencer, M.D.
• Sports Medicine and Regenerative Orthopedics, PLLC
• Sports Medicine and Regenerative Orthopedics, PLLC
• Ashley Elisabeth Springer, PA-C
• Suha Sreeram, M.D.
• St Joseph Medical Center
• St Joseph Physician Associates
• St Joseph Physician Associates

• Orthopedic Physical Therapist in Bryan, TX
• Providers in Bryan, TX by specialty
• Orthopedic Physical Therapist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.