MEDICARE: MRS. MELISSA BRADY RT.T

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	2471R0002X	Radiation Therapy Radiologic Technologist	28218	TX

General Provider Information

NPI Number	:	1417065095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELISSA BRADY RT.T

Provider Business Mailing Address
First Line	:	5514 GRIGGS RD
Second Line	:	APT 1333
City	:	HOUSTON
State	:	TX
Zip	:	77021-3761
Country	:	US
Telephone Number	:	504-905-8813
Fax Number	:

Provider Business Practice Location Address
First Line	:	5514 GRIGGS RD
Second Line	:	APT 1333
City	:	HOUSTON
State	:	TX
Zip	:	77021-3761
Country	:	US
Telephone Number	:	504-905-8813
Fax Number	:

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

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	07/08/2007

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