Provider Demographics
NPI:1417065095
Name:BRADY, MELISSA (RTT)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:BRADY
Suffix:
Gender:F
Credentials:RTT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5514 GRIGGS RD
Mailing Address - Street 2:APT 1333
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77021-3761
Mailing Address - Country:US
Mailing Address - Phone:504-905-8813
Mailing Address - Fax:
Practice Address - Street 1:5514 GRIGGS RD
Practice Address - Street 2:APT 1333
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77021-3761
Practice Address - Country:US
Practice Address - Phone:504-905-8813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX282182471R0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471R0002XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiation Therapy