Provider Demographics
NPI:1407037427
Name:BRADY, ANN (PT)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:
Last Name:BRADY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-7302
Mailing Address - Country:US
Mailing Address - Phone:781-643-3882
Mailing Address - Fax:
Practice Address - Street 1:5 HIGH ST
Practice Address - Street 2:SUITE 203
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-3860
Practice Address - Country:US
Practice Address - Phone:781-395-7333
Practice Address - Fax:781-395-7331
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8251225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY67093OtherBLUE CROSS BLUE SHIELD