Provider Demographics
NPI:1831753748
Name:OBRADY, DARIUS (PTA)
Entity type:Individual
Prefix:
First Name:DARIUS
Middle Name:
Last Name:OBRADY
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 DEERFERN CRES
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-4606
Mailing Address - Country:US
Mailing Address - Phone:443-850-8655
Mailing Address - Fax:
Practice Address - Street 1:711 W 40TH ST STE 352
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-2100
Practice Address - Country:US
Practice Address - Phone:410-243-5399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA4754225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant