Provider Demographics
NPI:1669893434
Name:BRADY, CYNTHIA ANN (PTA)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:ANN
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 1:813 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:CHETOPA
Mailing Address - State:KS
Mailing Address - Zip Code:67336-8990
Mailing Address - Country:US
Mailing Address - Phone:620-236-7491
Mailing Address - Fax:620-236-7491
Practice Address - Street 1:813 WALNUT ST
Practice Address - Street 2:
Practice Address - City:CHETOPA
Practice Address - State:KS
Practice Address - Zip Code:67336-8990
Practice Address - Country:US
Practice Address - Phone:620-236-7491
Practice Address - Fax:620-236-7491
Is Sole Proprietor?:No
Enumeration Date:2013-12-22
Last Update Date:2013-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-02407225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant