Basic Information
| Provider Information | |||||||||
| NPI: | 1780359083 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GATES | ||||||||
| FirstName: | BRENDAN | ||||||||
| MiddleName: | PATRICK | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PT, DPT, CSCS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12 LEACH LN | ||||||||
| Address2: | |||||||||
| City: | ASHLAND | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017211804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085050421 | ||||||||
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| Practice Location | |||||||||
| Address1: | 34 WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | WELLESLEY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024811934 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7812639993 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2021 | ||||||||
| LastUpdateDate: | 08/10/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 25623 | MA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.