Provider Demographics
NPI:1245463918
Name:BRADY, BROOKS L (DPT)
Entity type:Individual
Prefix:
First Name:BROOKS
Middle Name:L
Last Name:BRADY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 CENTRAL PARK AVE STE L
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8807
Mailing Address - Country:US
Mailing Address - Phone:910-215-0541
Mailing Address - Fax:910-215-9886
Practice Address - Street 1:211 CENTRAL PARK AVE STE L
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8807
Practice Address - Country:US
Practice Address - Phone:910-215-0541
Practice Address - Fax:910-215-9886
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-28
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13318225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist