MEDICARE: JAYLEN FRADY PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT012338	GA

General Provider Information

NPI Number	:	1487159026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAYLEN FRADY PT, DPT

Provider Business Mailing Address
First Line	:	1776 TOCCOA HWY
Second Line	:
City	:	MOUNT AIRY
State	:	GA
Zip	:	30563-1604
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1776 TOCCOA HWY
Second Line	:
City	:	MOUNT AIRY
State	:	GA
Zip	:	30563-1604
Country	:	US
Telephone Number	:	706-515-5492
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2018
Last Update Date	:	03/27/2018

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