Provider Demographics
NPI:1083213938
Name:HELFERTY, BRENDAN JOHN (DPT)
Entity Type:Individual
Prefix:DR
First Name:BRENDAN
Middle Name:JOHN
Last Name:HELFERTY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 12TH ST STE 25
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-2415
Mailing Address - Country:US
Mailing Address - Phone:209-549-9875
Mailing Address - Fax:
Practice Address - Street 1:400 12TH ST STE 25
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-2415
Practice Address - Country:US
Practice Address - Phone:209-549-9875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT028824225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist