Healthcare Provider Details

I. General information

NPI: 1588215420
Provider Name (Legal Business Name): THOMAS A BRADY SPORTS MEDICINE CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2019
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 S CREASY LN STE 100A
LAFAYETTE IN
47905-5206
US

IV. Provider business mailing address

201 PENNSYLVANIA PKWY STE 100
CARMEL IN
46280-1393
US

V. Phone/Fax

Practice location:
  • Phone: 317-817-1200
  • Fax: 317-817-1220
Mailing address:
  • Phone: 317-817-1200
  • Fax: 317-817-1220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK J RITTER
Title or Position: PRESIDENT
Credential: MD
Phone: 317-817-1200