Provider Demographics
NPI:1356906036
Name:GRUETT, BRADY
Entity type:Individual
Prefix:
First Name:BRADY
Middle Name:
Last Name:GRUETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W4697 ERTL RD
Mailing Address - Street 2:
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952-9791
Mailing Address - Country:US
Mailing Address - Phone:920-284-7040
Mailing Address - Fax:
Practice Address - Street 1:1475 ENGINEERING DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53706-1607
Practice Address - Country:US
Practice Address - Phone:608-264-8065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-07
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer