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General NPI Number Information
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NPI Number | 1427028869
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Entity Type | Individual
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Provider Name | TARA C. BRADY PHYSICAL THERAPIST
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Gender | Female
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Dates
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Enumeration Date | 01/26/2006
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Last Update Date | 04/11/2025
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Provider Practice Location Address
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Address Line | 535 W BUTLER RD STE A
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City | GREENVILLE
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State | SC
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Zip | 29607-4833
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Country | US
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Telephone | 864-277-2747
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Fax |
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Provider Business Mailing Address
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Address Line | 200 TIMBERLEAF DR
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City | DUNCAN
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State | SC
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Zip | 29334-9297
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Country | US
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Telephone | 845-304-3905
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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 | 11086
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License Number State | SC
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