Provider Demographics
NPI:1427106111
Name:KIMBLE, BRADLEY JOHNSON (MED, ATC, LAT)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:JOHNSON
Last Name:KIMBLE
Suffix:
Gender:M
Credentials:MED, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RICE UNIVERSITY
Mailing Address - Street 2:6100 MAIN STREET, MS 552
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005
Mailing Address - Country:US
Mailing Address - Phone:713-348-4738
Mailing Address - Fax:713-348-5622
Practice Address - Street 1:6100 MAIN ST # MS 552
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005-1827
Practice Address - Country:US
Practice Address - Phone:713-348-6363
Practice Address - Fax:713-348-5622
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT.0024602255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer