Provider Demographics
NPI:1962528026
Name:TRIPP, BRADY (PHD, ATC, LAT)
Entity type:Individual
Prefix:DR
First Name:BRADY
Middle Name:
Last Name:TRIPP
Suffix:
Gender:M
Credentials:PHD, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5465 SW 125TH TER
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-5487
Mailing Address - Country:US
Mailing Address - Phone:305-348-3167
Mailing Address - Fax:
Practice Address - Street 1:250B UNIVERSITY PARK ZEB
Practice Address - Street 2:11200 S.W. 8TH STREET
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33199-0001
Practice Address - Country:US
Practice Address - Phone:305-348-3167
Practice Address - Fax:305-348-3571
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20542255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer