Provider Demographics
NPI:1780359083
Name:GATES, BRENDAN PATRICK (PT, DPT, CSCS)
Entity type:Individual
Prefix:DR
First Name:BRENDAN
Middle Name:PATRICK
Last Name:GATES
Suffix:
Gender:M
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 LEACH LN
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01721-1804
Mailing Address - Country:US
Mailing Address - Phone:508-505-0421
Mailing Address - Fax:
Practice Address - Street 1:34 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-1934
Practice Address - Country:US
Practice Address - Phone:781-263-9993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA25623225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist