MEDICARE: DANIEL THOMAS BRADY 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	225100000X	Physical Therapist	PT7594	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00PT75942	OTHER	CA	PTAN

General Provider Information

NPI Number	:	1932102738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL THOMAS BRADY P.T.

Provider Business Mailing Address
First Line	:	121 G ST
Second Line	:
City	:	REDWOOD CITY
State	:	CA
Zip	:	94063-1043
Country	:	US
Telephone Number	:	650-571-6800
Fax Number	:	650-571-1260

Provider Business Practice Location Address
First Line	:	1171 FREMONT ST
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95126-2109
Country	:	US
Telephone Number	:	650-571-6800
Fax Number	:	650-571-1260

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	09/01/2021

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