Provider Demographics
NPI:1255019642
Name:BRADY, CAROLINA (PTA)
Entity type:Individual
Prefix:
First Name:CAROLINA
Middle Name:
Last Name:BRADY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 PRAIRIE ST
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77562-2833
Mailing Address - Country:US
Mailing Address - Phone:281-782-2514
Mailing Address - Fax:
Practice Address - Street 1:705 PRAIRIE ST
Practice Address - Street 2:
Practice Address - City:HIGHLANDS
Practice Address - State:TX
Practice Address - Zip Code:77562-2833
Practice Address - Country:US
Practice Address - Phone:281-782-2514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2166427225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant