Provider Demographics
NPI:1427028869
Name:BRADY, TARA C (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:C
Last Name:BRADY
Suffix:
Gender:
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 TIMBERLEAF DR
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:SC
Mailing Address - Zip Code:29334-9297
Mailing Address - Country:US
Mailing Address - Phone:845-304-3905
Mailing Address - Fax:
Practice Address - Street 1:535 W BUTLER RD STE A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-4833
Practice Address - Country:US
Practice Address - Phone:864-277-2747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11086225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQN0201Medicare ID - Type UnspecifiedMEDICARE