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Individual

DR. BRADY LYNN CARTER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PT DPT

Contact information

Practice address
3130 LEE HIGHWAY, SUITE 210, BRISTOL, VA 24202-5943
(276) 645-0311
(276) 645-0302
Mailing address
3130 LEE HWY, STE 210, BRISTOL, VA 24202-6026
(276) 645-0311
(276) 645-0302

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305831292
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
010259053
VA
01
03-0577077
TRI-CARE #
VA
01
030577077
TAX ID #
VA
01
193497
ANTHEM PROVIDER #
VA
01
700683
UNITED HEALTHCARE - ACN #
VA
01
7195849
AETNA PROVIDER #
VA
01
VA0100
JOHN DEERE PROVIDER #
VA
Enumeration date
10/06/2006
Last updated
07/20/2022
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