Provider Demographics
NPI:1508821810
Name:BRADY, EDWARD P (RPT)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:P
Last Name:BRADY
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 CHALKSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-4220
Mailing Address - Country:US
Mailing Address - Phone:401-272-9500
Mailing Address - Fax:401-272-9540
Practice Address - Street 1:955 CHALKSTONE AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-4220
Practice Address - Country:US
Practice Address - Phone:401-272-9500
Practice Address - Fax:401-272-9540
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT013792251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic