Provider Demographics
NPI:1659854784
Name:CHRISTOPH, BRADY GLENN (DPT)
Entity Type:Individual
Prefix:DR
First Name:BRADY
Middle Name:GLENN
Last Name:CHRISTOPH
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 1:4823 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-3101
Mailing Address - Country:US
Mailing Address - Phone:253-753-0255
Mailing Address - Fax:
Practice Address - Street 1:AUBURN SCHOOL DISTRICT
Practice Address - Street 2:29205 132ND AVE SE
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98092
Practice Address - Country:US
Practice Address - Phone:253-753-0255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA606789952251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics