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General NPI Number Information
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NPI Number | 1427173913
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Entity Type | Individual
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Provider Name | TRACY LYNN BRADY PTA
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Gender | Female
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 11/28/2012
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Provider Practice Location Address
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Address Line | 146 WATER ST. SALEM CARE AND REHABILITATION
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City | SALEM
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State | WV
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Zip | 26426
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Country | US
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Telephone | 304-782-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 1533 HOFFMAN AVE
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City | CLARKSBURG
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State | WV
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Zip | 26301
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Country | US
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Telephone | 215-675-5027
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | TEE007620
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 001364
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License Number State | WV
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Taxonomy #3
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | A4675
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License Number State | NC
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