Provider Demographics
NPI:1962513861
Name:BRADY, JAMES CARROLL (MS PT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:CARROLL
Last Name:BRADY
Suffix:
Gender:M
Credentials:MS PT
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Mailing Address - Street 1:8006 WESTOVER DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231
Mailing Address - Country:US
Mailing Address - Phone:214-342-8452
Mailing Address - Fax:
Practice Address - Street 1:7338 S WESTMORELAND
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237
Practice Address - Country:US
Practice Address - Phone:972-572-5299
Practice Address - Fax:972-572-5270
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1049500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX169087701Medicaid
TX169087701Medicaid