Provider Demographics
NPI:1134790694
Name:BRADY PEDIATRIC THERAPY LLC
Entity type:Organization
Organization Name:BRADY PEDIATRIC THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:217-714-8333
Mailing Address - Street 1:350 HAMILTON PKWY
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29642-3040
Mailing Address - Country:US
Mailing Address - Phone:217-713-8333
Mailing Address - Fax:
Practice Address - Street 1:350 HAMILTON PKWY
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29642-3040
Practice Address - Country:US
Practice Address - Phone:217-713-8333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-06
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty