Provider Demographics
NPI:1164021499
Name:BROCATO, MARY GAINES (PT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:GAINES
Last Name:BROCATO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 LINDEN AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:AL
Mailing Address - Zip Code:35209-2544
Mailing Address - Country:US
Mailing Address - Phone:205-490-8046
Mailing Address - Fax:205-449-4635
Practice Address - Street 1:2910 LINDEN AVE STE 103
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:AL
Practice Address - Zip Code:35209-2544
Practice Address - Country:US
Practice Address - Phone:205-490-8046
Practice Address - Fax:205-449-4635
Is Sole Proprietor?:No
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH7755225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist