Healthcare Provider Details

I. General information

NPI: 1386005304
Provider Name (Legal Business Name): BREDY PHYSICAL THERAPY AND SPORTS REHAB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2016
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10590 INDEPENDENCE POINTE PKWY STE 201
MATTHEWS NC
28105-4176
US

IV. Provider business mailing address

10590 INDEPENDENCE POINTE PKWY STE 201
MATTHEWS NC
28105-4176
US

V. Phone/Fax

Practice location:
  • Phone: 704-246-7026
  • Fax: 704-246-6527
Mailing address:
  • Phone: 704-246-7026
  • Fax: 704-246-6527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. VANIA BREDY
Title or Position: CEP
Credential:
Phone: 704-246-7026