Provider Demographics
NPI:1144008954
Name:GRIFFITH, BRADY
Entity type:Individual
Prefix:
First Name:BRADY
Middle Name:
Last Name:GRIFFITH
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 1:639 S BROOKE CIR
Mailing Address - Street 2:
Mailing Address - City:BLISSFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:49228-8607
Mailing Address - Country:US
Mailing Address - Phone:517-215-2509
Mailing Address - Fax:
Practice Address - Street 1:197 STATE ST
Practice Address - Street 2:
Practice Address - City:BOYNE CITY
Practice Address - State:MI
Practice Address - Zip Code:49712-1288
Practice Address - Country:US
Practice Address - Phone:231-582-6265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI55013025482251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic