MEDICARE: MICHAEL O'GRADY PT

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	2305205171	VA

General Provider Information

NPI Number	:	1669501755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL O'GRADY PT

Provider Business Mailing Address
First Line	:	12625A LEE HWY
Second Line	:
City	:	WASHINGTON
State	:	VA
Zip	:	22747-1931
Country	:	US
Telephone Number	:	540-987-9395
Fax Number	:

Provider Business Practice Location Address
First Line	:	12625A LEE HWY
Second Line	:
City	:	WASHINGTON
State	:	VA
Zip	:	22747-1931
Country	:	US
Telephone Number	:	540-987-9395
Fax Number	:

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

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	06/22/2021

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