Provider Demographics
NPI:1508281460
Name:BRADY, JEREMY L (PT, DPT, CERT MDT)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:L
Last Name:BRADY
Suffix:
Gender:M
Credentials:PT, DPT, CERT MDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 W BOLZ RD UNIT 1930
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:OR
Mailing Address - Zip Code:97535-6647
Mailing Address - Country:US
Mailing Address - Phone:541-622-2426
Mailing Address - Fax:541-227-6149
Practice Address - Street 1:205 ELM ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:OR
Practice Address - Zip Code:97535-7759
Practice Address - Country:US
Practice Address - Phone:541-622-2426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-28
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1236820225100000X
OR61159225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist