Provider Demographics
NPI:1427173913
Name:BRADY, TRACY LYNN (PTA)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:LYNN
Last Name:BRADY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1533 HOFFMAN AVE
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301
Mailing Address - Country:US
Mailing Address - Phone:215-675-5027
Mailing Address - Fax:
Practice Address - Street 1:146 WATER ST.
Practice Address - Street 2:SALEM CARE AND REHABILITATION
Practice Address - City:SALEM
Practice Address - State:WV
Practice Address - Zip Code:26426
Practice Address - Country:US
Practice Address - Phone:304-782-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEE007620225200000X
WV001364225200000X
NCA4675225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant