Healthcare Provider Details

I. General information

NPI: 1962221002
Provider Name (Legal Business Name): BRYAN PADON ANTHONY RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 WASHINGTON ST
NORWELL MA
02061-1740
US

IV. Provider business mailing address

4 WESTGATE LN
SCITUATE MA
02066-2410
US

V. Phone/Fax

Practice location:
  • Phone: 781-290-3886
  • Fax:
Mailing address:
  • Phone: 617-218-7775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-383181
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: