MEDICARE: DANIEL T. BRADY

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	PT7594	CA

General Provider Information

NPI Number	:	1437189263
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANIEL T. BRADY

Provider Business Mailing Address
First Line	:	557 PILGRIM DR
Second Line	:	B
City	:	FOSTER CITY
State	:	CA
Zip	:	94404-5106
Country	:	US
Telephone Number	:	650-571-6800
Fax Number	:	650-571-1260

Provider Business Practice Location Address
First Line	:	557 PILGRIM DR
Second Line	:	B
City	:	FOSTER CITY
State	:	CA
Zip	:	94404-5106
Country	:	US
Telephone Number	:	650-571-6800
Fax Number	:	650-571-1260

Authorized Official
Title or Position	:	OWNER
Name	:	MR. DANIEL THOMAS BRADY
Credential	:	R.P.T.
Telephone Number	:	650-571-6800

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	08/22/2020

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