Provider Demographics
NPI:1578131082
Name:BRADY, ABBIGALE SUE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ABBIGALE
Middle Name:SUE
Last Name:BRADY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 SUNCRIST ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-4334
Mailing Address - Country:US
Mailing Address - Phone:989-430-9334
Mailing Address - Fax:
Practice Address - Street 1:4616 STATE ST
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-3805
Practice Address - Country:US
Practice Address - Phone:989-355-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-12
Last Update Date:2021-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501020035225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist