Provider Demographics
NPI:1518666973
Name:BRADY, JARED PERRY (DPT)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:PERRY
Last Name:BRADY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:561 W 1400 N
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-2598
Mailing Address - Country:US
Mailing Address - Phone:385-335-3351
Mailing Address - Fax:
Practice Address - Street 1:524 W 300 N STE 201
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84601-2669
Practice Address - Country:US
Practice Address - Phone:801-370-9981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-24
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT131487872401208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty