Provider Demographics
NPI:1689561821
Name:GREENLEE, BRADY ALEXANDER (MAT, LAT, ATC)
Entity type:Individual
Prefix:
First Name:BRADY
Middle Name:ALEXANDER
Last Name:GREENLEE
Suffix:
Gender:M
Credentials:MAT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 PARK PLACE BLVD APT 8204
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-3395
Mailing Address - Country:US
Mailing Address - Phone:432-258-6145
Mailing Address - Fax:
Practice Address - Street 1:ENNIS ISD
Practice Address - Street 2:2301 ENSIGN RD
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119
Practice Address - Country:US
Practice Address - Phone:972-872-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-20
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT98692255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer