Provider Demographics
NPI:1417147323
Name:BRADY, BETHANY JO (DPT)
Entity Type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:JO
Last Name:BRADY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1329 E HWY 89A
Mailing Address - Street 2:STE D
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-4506
Mailing Address - Country:US
Mailing Address - Phone:928-301-9869
Mailing Address - Fax:
Practice Address - Street 1:856 COVE PKWY
Practice Address - Street 2:ST A-B
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-5449
Practice Address - Country:US
Practice Address - Phone:928-301-9869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-26
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7760225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist