Provider Demographics
NPI:1871318477
Name:BRADY, REBECCA SUE
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:SUE
Last Name:BRADY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BLYTHEWOOD DR STE A
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-4828
Mailing Address - Country:US
Mailing Address - Phone:931-381-1920
Mailing Address - Fax:931-548-8360
Practice Address - Street 1:100 BLYTHEWOOD DR STE A
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-4828
Practice Address - Country:US
Practice Address - Phone:931-381-1920
Practice Address - Fax:931-548-8360
Is Sole Proprietor?:No
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program