Provider Demographics
NPI:1114632791
Name:BRADY, KAYSHIA (ATC)
Entity Type:Individual
Prefix:
First Name:KAYSHIA
Middle Name:
Last Name:BRADY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1096 CAREFREE COVE DR
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-9503
Mailing Address - Country:US
Mailing Address - Phone:386-916-6615
Mailing Address - Fax:
Practice Address - Street 1:1096 CAREFREE COVE DR
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-9503
Practice Address - Country:US
Practice Address - Phone:386-916-6615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL45912255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer