MEDICARE: DR. JEREMY L BRADY PT, DPT, CERT. MDT

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	1236820	TX
2	225100000X	Physical Therapist	61159	OR

General Provider Information

NPI Number	:	1508281460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEREMY L BRADY PT, DPT, CERT. MDT

Provider Business Mailing Address
First Line	:	105 W BOLZ RD UNIT 1930
Second Line	:
City	:	PHOENIX
State	:	OR
Zip	:	97535-6647
Country	:	US
Telephone Number	:	541-622-2426
Fax Number	:	541-227-6149

Provider Business Practice Location Address
First Line	:	205 ELM ST
Second Line	:
City	:	PHOENIX
State	:	OR
Zip	:	97535-7759
Country	:	US
Telephone Number	:	541-622-2426
Fax Number	:

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

Provider Enumeration Date	:	02/28/2014
Last Update Date	:	02/01/2024

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