Provider Demographics
NPI:1033766985
Name:GONSALVES, BRITANY MICHELLE (PTA)
Entity Type:Individual
Prefix:
First Name:BRITANY
Middle Name:MICHELLE
Last Name:GONSALVES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:BRITANY
Other - Middle Name:MICHELLE
Other - Last Name:DURETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:104 WILBUR ST APT 3
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02724-6239
Mailing Address - Country:US
Mailing Address - Phone:401-835-2742
Mailing Address - Fax:
Practice Address - Street 1:600 VALLEY RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-7029
Practice Address - Country:US
Practice Address - Phone:401-846-0743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-23
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPTA01165208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation