Provider Demographics
NPI:1275535288
Name:LACHANCE, BRENDON DANIEL (MS, PT)
Entity Type:Individual
Prefix:MR
First Name:BRENDON
Middle Name:DANIEL
Last Name:LACHANCE
Suffix:
Gender:M
Credentials:MS, PT
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Mailing Address - Street 1:247 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:MA
Mailing Address - Zip Code:02152-1313
Mailing Address - Country:US
Mailing Address - Phone:617-846-1490
Mailing Address - Fax:617-561-4924
Practice Address - Street 1:8 CHELSEA ST
Practice Address - Street 2:
Practice Address - City:EAST BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02128-1913
Practice Address - Country:US
Practice Address - Phone:617-561-4777
Practice Address - Fax:617-561-4924
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA15139225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0017651OtherNEIGHBORHOOD HEALTH PLAN
MA0330299Medicaid
MA64-02350OtherUNITED HEALTH CARE
MAY67795OtherBLUE CROSS
MA2594521OtherAETNA/US HEALTH CARE
MA307647OtherHARVARD PILGRIM
MA2594521OtherAETNA/US HEALTH CARE