=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912186966
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRAD M GILDEN DPT, FAAOMPT, PRC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/26/2007
-----------------------------------------------------
Last Update Date | 01/22/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1445 E PUTNAM AVE STE 2
-----------------------------------------------------
City | OLD GREENWICH
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06870-1377
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-983-5748
-----------------------------------------------------
Fax | 203-869-1144
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1445 E PUTNAM AVE STE 2
-----------------------------------------------------
City | OLD GREENWICH
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06870-1377
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-983-5748
-----------------------------------------------------
Fax | 203-869-1144
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------