Provider Demographics
NPI:1871329656
Name:BRADY, ASHLEY (DPT)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:BRADY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 OSIGIAN BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-8978
Mailing Address - Country:US
Mailing Address - Phone:478-333-3075
Mailing Address - Fax:478-333-6625
Practice Address - Street 1:6040 LAKESIDE COMMONS DR STE A
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-5794
Practice Address - Country:US
Practice Address - Phone:782-546-8804
Practice Address - Fax:478-254-6883
Is Sole Proprietor?:No
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT017262225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist