Provider Demographics
NPI:1952404212
Name:MCDADE, BRYAN P
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:P
Last Name:MCDADE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 EUREKA SQ
Mailing Address - Street 2:UNIT 217
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-2654
Mailing Address - Country:US
Mailing Address - Phone:650-557-0885
Mailing Address - Fax:650-477-1506
Practice Address - Street 1:80 EUREKA SQ
Practice Address - Street 2:UNIT 217
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-2654
Practice Address - Country:US
Practice Address - Phone:650-557-0885
Practice Address - Fax:650-477-1506
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics