Healthcare Provider Details

I. General information

NPI: 1831009927
Provider Name (Legal Business Name): BRENNAN GRADY DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 WAYNE ST
OLEAN NY
14760-2355
US

IV. Provider business mailing address

610 WAYNE ST
OLEAN NY
14760-2355
US

V. Phone/Fax

Practice location:
  • Phone: 716-790-8418
  • Fax: 716-790-8447
Mailing address:
  • Phone: 716-790-8418
  • Fax: 716-790-8447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number056006
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: