MEDICARE: MR. BRENDON DANIEL LACHANCE MS, PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	15139	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0017651	OTHER	MA	NEIGHBORHOOD HEALTH PLAN
2	307647	OTHER	MA	HARVARD PILGRIM
3	Y67795	OTHER	MA	BLUE CROSS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	64-02350	OTHER	MA	UNITED HEALTH CARE
6	2594521	OTHER	MA	AETNA/US HEALTH CARE

General Provider Information

NPI Number	:	1275535288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRENDON DANIEL LACHANCE MS, PT

Provider Business Mailing Address
First Line	:	115 PORTER ST
Second Line	:
City	:	EAST BOSTON
State	:	MA
Zip	:	02128-2110
Country	:	US
Telephone Number	:	617-569-2929
Fax Number	:	617-569-2925

Provider Business Practice Location Address
First Line	:	115 PORTER ST
Second Line	:
City	:	EAST BOSTON
State	:	MA
Zip	:	02128-2110
Country	:	US
Telephone Number	:	617-569-2929
Fax Number	:	617-569-2925

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	09/24/2025

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