Individual
ROBERT G BRADY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
320 N WISCONSIN ST, DE PERE, WI 54115-2737
(920) 857-1622
Mailing address
2836 STEAMBOAT SPRINGS RUN, GREEN BAY, WI 54313-9220
(920) 680-1599
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
9918-24
WI
2251X0800X
Orthopedic Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40375700
—
WI
01
—
9918-024
LICENSE NUMBER
WI
Enumeration date
09/06/2006
Last updated
08/04/2024
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