Provider Demographics
NPI:1427028869
Name:BRADY, TARA C (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:C
Last Name:BRADY
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 TIMBERLEAF DR
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:SC
Mailing Address - Zip Code:29334-9297
Mailing Address - Country:US
Mailing Address - Phone:845-304-3905
Mailing Address - Fax:
Practice Address - Street 1:345 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-4305
Practice Address - Country:US
Practice Address - Phone:845-638-4040
Practice Address - Fax:845-638-4184
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0211111174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQN0201Medicare ID - Type UnspecifiedMEDICARE