Provider Demographics
NPI:1972074607
Name:STOKES, BRADY SCOTT (PT, DPT, CIDN)
Entity Type:Individual
Prefix:DR
First Name:BRADY
Middle Name:SCOTT
Last Name:STOKES
Suffix:
Gender:M
Credentials:PT, DPT, CIDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3792 ALMY ROAD 107
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82930-8940
Mailing Address - Country:US
Mailing Address - Phone:307-679-4959
Mailing Address - Fax:
Practice Address - Street 1:195 FEATHER WAY
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-9352
Practice Address - Country:US
Practice Address - Phone:307-679-4959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1497225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist