Provider Demographics
NPI:1528135928
Name:BRADY, NANCY ALICE (PT)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:ALICE
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:PO BOX 40480
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36640-0480
Mailing Address - Country:US
Mailing Address - Phone:251-470-5842
Mailing Address - Fax:251-470-5809
Practice Address - Street 1:1707 CENTER ST
Practice Address - Street 2:SUITE 201
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-3307
Practice Address - Country:US
Practice Address - Phone:251-415-8577
Practice Address - Fax:251-415-8578
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL997225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1528135928Medicaid
AL51546148OtherBCBS 1610 CENTER ST
AL51539349OtherBCBS 1707 CENTER ST
MS02235218Medicaid