Provider Demographics
NPI:1598331597
Name:BASSETT, BRADY SPENCER (MSE, LAT)
Entity Type:Individual
Prefix:
First Name:BRADY
Middle Name:SPENCER
Last Name:BASSETT
Suffix:
Gender:M
Credentials:MSE, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20303 BLUE SAGE PKWY
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-3721
Mailing Address - Country:US
Mailing Address - Phone:402-289-0616
Mailing Address - Fax:
Practice Address - Street 1:20303 BLUE SAGE PKWY
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-3721
Practice Address - Country:US
Practice Address - Phone:402-289-0616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9262255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer