Provider Demographics
NPI:1881303659
Name:WINGATE, BRIAN (LMT)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:WINGATE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:544 WESTBORO DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-1744
Mailing Address - Country:US
Mailing Address - Phone:615-496-0782
Mailing Address - Fax:
Practice Address - Street 1:2021 21ST AVE S STE 309
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-4358
Practice Address - Country:US
Practice Address - Phone:615-496-0782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4011225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty