Provider Demographics
NPI:1134576945
Name:GRADY, RORY A JR (ATC)
Entity type:Individual
Prefix:MR
First Name:RORY
Middle Name:A
Last Name:GRADY
Suffix:JR
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:22575 LEANNE TER APT 444
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20148-6858
Mailing Address - Country:US
Mailing Address - Phone:516-423-1962
Mailing Address - Fax:703-237-1465
Practice Address - Street 1:6600 LITTLE FALLS RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22213-1211
Practice Address - Country:US
Practice Address - Phone:703-237-1456
Practice Address - Fax:703-237-1465
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-21
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0023172255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer