Provider Demographics
NPI:1013924554
Name:BRADY, MARTINA L (ATC)
Entity Type:Individual
Prefix:MRS
First Name:MARTINA
Middle Name:L
Last Name:BRADY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:MS
Other - First Name:MARTINA
Other - Middle Name:L
Other - Last Name:LUCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:91 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-1354
Mailing Address - Country:US
Mailing Address - Phone:516-426-9607
Mailing Address - Fax:
Practice Address - Street 1:1983 MARCUS AVE STE 117
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1016
Practice Address - Country:US
Practice Address - Phone:516-297-0079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0013712255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer