Provider Demographics
NPI:1922246198
Name:BRADY, AMBER LYNN (DPT)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:LYNN
Last Name:BRADY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:LYNN
Other - Last Name:HENRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:6747 NEWELL LOOP
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:34762-7002
Mailing Address - Country:US
Mailing Address - Phone:803-309-3502
Mailing Address - Fax:
Practice Address - Street 1:2518 BURNSED BLVD STE 441
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32163-2704
Practice Address - Country:US
Practice Address - Phone:352-457-2515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-27
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL40286225100000X
MO2010024110225100000X
SC5899225100000X
NC12169225100000X
IL070-19876225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist