Clayton H. Brakeville, M.S.P.T.
Individual provider Active NPI Physical Therapist · Carthage, TX
NPI 1740374164 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1740374164
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 1128072 (TX)
- Practice address
- 107 S. Daniels St
Carthage, TX 75633 - Phone
- (903) 694-9371
- Fax
- (903) 694-2898
- NPI assigned
- Oct 2, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 1992
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
107 S Daniels St
Carthage, TX 75633-1571
Phone (903) 694-9371
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100914000482 | TX | Practitioner - Physical Therapist in Private Practice | 7315934221 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Carthage Physical Therapy, PLLC | Physical Therapist | Current |
Accepting new patients |
Locations
325 W Sabine St
Ste F
Carthage, TX 75633
Phone (318) 868-8536
107 S Daniels St
Carthage, TX 75633
Phone (903) 694-9371
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 1128072 | TX | Yes |
Addresses
Primary practice location
107 S. Daniels St
Carthage, TX 75633
Mailing address
107 S. Daniels St
Carthage, TX 75633
Phone (903) 694-9371
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 83356T | Other | TX | BLUE CROSS PROVIDER # |
Other providers in Carthage, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.