MEDICARE: AMBER LEAH BRADY PTA

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	225200000X	Physical Therapy Assistant	40QB00312600	NJ

General Provider Information

NPI Number	:	1689630337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER LEAH BRADY PTA

Provider Business Mailing Address
First Line	:	5 GREEN ST
Second Line	:
City	:	HACKETTSTOWN
State	:	NJ
Zip	:	07840-1762
Country	:	US
Telephone Number	:	715-965-2470
Fax Number	:

Provider Business Practice Location Address
First Line	:	1940 COMMERCE ST
Second Line	:	SUITE 210
City	:	YORKTOWN HEIGHTS
State	:	NY
Zip	:	10598-4428
Country	:	US
Telephone Number	:	914-631-9020
Fax Number	:

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

Provider Enumeration Date	:	04/21/2006
Last Update Date	:	09/03/2014

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