MEDICARE: MR. BRADY C MARTIN P.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	2251X0800X	Orthopedic Physical Therapist	23377	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	WPT22377C	OTHER	CA	PPIN

General Provider Information

NPI Number	:	1578512950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRADY C MARTIN P.T.

Provider Business Mailing Address
First Line	:	27126 PASEO ESPADA STE 1621
Second Line	:
City	:	SAN JUAN CAPISTRANO
State	:	CA
Zip	:	92675-6703
Country	:	US
Telephone Number	:	949-347-1021
Fax Number	:	949-347-0981

Provider Business Practice Location Address
First Line	:	27126 PASEO ESPADA STE 1621
Second Line	:
City	:	SAN JUAN CAPO
State	:	CA
Zip	:	92675-6703
Country	:	US
Telephone Number	:	949-347-1021
Fax Number	:	949-347-0981

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

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	10/29/2024

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