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General NPI Number Information
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NPI Number | 1114636016
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Entity Type | Individual
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Provider Name | BRADY EDWARD SMITH DPT
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Gender | Male
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Dates
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Enumeration Date | 11/18/2022
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Last Update Date | 11/18/2022
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Provider Practice Location Address
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Address Line | 800 4TH STREET SOUTH
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City | CARRINGTON
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State | ND
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Zip | 58421
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Country | US
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Telephone | 701-652-7179
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Fax |
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Provider Business Mailing Address
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Address Line | 734 2ND ST N
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City | CARRINGTON
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State | ND
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Zip | 58421-1617
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2613
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License Number State | ND
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