Healthcare Provider Details

I. General information

NPI: 1982854766
Provider Name (Legal Business Name): JASON H BRADY PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2008
Last Update Date: 01/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 EUREKA ST SUITE A
BATESVILLE MS
38606-2534
US

IV. Provider business mailing address

109 EUREKA ST SUITE A
BATESVILLE MS
38606-2534
US

V. Phone/Fax

Practice location:
  • Phone: 662-578-7799
  • Fax: 662-578-7992
Mailing address:
  • Phone: 662-578-7799
  • Fax: 662-578-7992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT4418
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: