Provider Demographics
NPI:1487741054
Name:CARTER, BRADY LYNN (PT DPT)
Entity type:Individual
Prefix:DR
First Name:BRADY
Middle Name:LYNN
Last Name:CARTER
Suffix:
Gender:M
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 LEE HWY
Mailing Address - Street 2:STE 210
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24202-6026
Mailing Address - Country:US
Mailing Address - Phone:276-645-0311
Mailing Address - Fax:276-645-0302
Practice Address - Street 1:3130 LEE HIGHWAY
Practice Address - Street 2:SUITE 210
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24202-5943
Practice Address - Country:US
Practice Address - Phone:276-645-0311
Practice Address - Fax:276-645-0302
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305831292225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA03-0577077OtherTRI-CARE #
VAVA0100OtherJOHN DEERE PROVIDER #
VA010259053Medicaid
VA030577077OtherTAX ID #
VA193497OtherANTHEM PROVIDER #
VA700683OtherUNITED HEALTHCARE - ACN #
VA030577077OtherREHAB PROVIDER NETWORK #
VA7195849OtherAETNA PROVIDER #