Provider Demographics
NPI:1356836456
Name:MCGRADY, BRENDON KYLE (MS, ATC)
Entity Type:Individual
Prefix:
First Name:BRENDON
Middle Name:KYLE
Last Name:MCGRADY
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6-6-703 ASAHIGAOKA
Mailing Address - Street 2:
Mailing Address - City:TOYONAKA
Mailing Address - State:OSAKA
Mailing Address - Zip Code:5610865
Mailing Address - Country:JP
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6-6-703 ASAHIGAOKA
Practice Address - Street 2:
Practice Address - City:TOYONAKA
Practice Address - State:OSAKA
Practice Address - Zip Code:5610865
Practice Address - Country:JP
Practice Address - Phone:090-946-3457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI0805021082255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer