Provider Demographics
NPI:1205316460
Name:GENDRON, BRITTANY (PT, DPT)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:GENDRON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13500 CABARRUS STATION RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28107-9399
Mailing Address - Country:US
Mailing Address - Phone:704-778-8582
Mailing Address - Fax:
Practice Address - Street 1:415 TOWN PARK BLVD
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3487
Practice Address - Country:US
Practice Address - Phone:706-868-1707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT013591225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist