Healthcare Provider Details

I. General information

NPI: 1114636016
Provider Name (Legal Business Name): BRADY EDWARD SMITH DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2022
Last Update Date: 11/18/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 4TH STREET SOUTH
CARRINGTON ND
58421
US

IV. Provider business mailing address

734 2ND ST N
CARRINGTON ND
58421-1617
US

V. Phone/Fax

Practice location:
  • Phone: 701-652-7179
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2613
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: