Individual provider Active NPI

Leon F. Bradway III, PHYSICIAL THERAPIST

  • Physical Therapist
  • College Station, TX
National Provider Identifier
1932179306
Registry record updated Apr 22, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
1055085 Issued in TX
Practice address
800 Scott and White Dr
College Station, TX 77845-6440
Phone
(979) 207-4000
Fax
(979) 207-4562
NPI assigned
Jan 26, 2006
Last updated
Apr 22, 2026By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 22, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 1055085 TX Primary

Addresses

Primary practice location

800 Scott and White Dr
College Station, TX 77845-6440

Mailing address

PO Box 844658
Dallas, TX 75284-4658
Phone (800) 994-0371

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address lbradway1504585@direct.sw.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090302000032 TX Practitioner - Physical Therapist in Private Practice 6800952789 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1055085TXMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Sports, Back & Pain Mangement Clinic Physical Therapist CurrentSince Oct 15, 2008 Accepting new patients
Emerelli, PLLC Physical Therapist CurrentSince Mar 17, 2025 Accepting new patients
Scott & White Clinic CurrentSince Feb 19, 2026 Accepting new patients
Scott & White Clinic CurrentSince Feb 19, 2026 Accepting new patients
Paul V Bonarrigo PastSince Oct 23, 2008 Accepting new patients

Locations

2011 E Villa Maria Rd
#A
Bryan, TX 77802
Phone (409) 776-2225

2011A E Villa Maria Rd
Bryan, TX 77802
Phone (409) 775-3728

2705 Osler Blvd
Bryan, TX 77802
Phone (979) 776-2225

2714 Osler Blvd
Bryan, TX 77802
Phone (979) 776-2225

800 Scott and White Dr
College Station, TX 77845
Phone (979) 207-3300

Interoperability endpoints

  • Direct secure messaging: lbradway1504585@direct.sw.org

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1138233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776816000000",
    "number": "1932179306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 844658",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752844658",
            "telephone_number": "800-994-0371",
            "fax_number": "254-215-9722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 SCOTT AND WHITE DR",
            "city": "COLLEGE STATION",
            "state": "TX",
            "postal_code": "778456440",
            "telephone_number": "979-207-4000",
            "fax_number": "979-207-4562"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADWAY",
        "first_name": "LEON",
        "middle_name": "F.",
        "name_suffix": "III",
        "credential": "PHYSICIAL THERAPIST",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-26",
        "last_updated": "2026-04-22",
        "certification_date": "2026-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1055085",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lbradway1504585@direct.sw.org",
            "affiliation": "N",
            "address_1": "800 Scott and White Dr",
            "city": "College Station",
            "state": "TX",
            "country_code": "US",
            "postal_code": "778456440",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in College Station, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.