Provider Demographics
NPI:1790093987
Name:ELLIOTT, BRADY BENJAMIN (CPED, CFO)
Entity Type:Individual
Prefix:MR
First Name:BRADY
Middle Name:BENJAMIN
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:CPED, CFO
Other - Prefix:
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Mailing Address - Street 1:5923 CLARK RD
Mailing Address - Street 2:STE C
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969
Mailing Address - Country:US
Mailing Address - Phone:530-872-3710
Mailing Address - Fax:530-872-7234
Practice Address - Street 1:5923 CLARK RD
Practice Address - Street 2:STE C
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969
Practice Address - Country:US
Practice Address - Phone:530-872-3710
Practice Address - Fax:530-872-7234
Is Sole Proprietor?:No
Enumeration Date:2010-09-22
Last Update Date:2014-12-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter