MEDICARE: BRADY POWELL PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1207843	TX
2	2251S0007X	Sports Physical Therapist	3099	NV
3	2251X0800X	Orthopedic Physical Therapist	3099	NV
4	225100000X	Physical Therapist	3099	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053712166
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRADY POWELL PT, DPT

Provider Business Mailing Address
First Line	:	2225 CIVIC CENTER DR STE 100
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-6328
Country	:	US
Telephone Number	:	702-586-5778
Fax Number	:	702-586-5758

Provider Business Practice Location Address
First Line	:	2225 CIVIC CENTER DR STE 100
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-6328
Country	:	US
Telephone Number	:	702-586-5778
Fax Number	:	702-586-5758

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2014
Last Update Date	:	08/16/2022

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