MEDICARE: HEALTHGAPS, LLC

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	172M00000X	Mechanotherapist
2	225700000X	Massage Therapist

General Provider Information

NPI Number	:	1063701860
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHGAPS, LLC

Provider Business Mailing Address
First Line	:	2670 S. VOYAGER DR., SUITE 101
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85295-1294
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4111 EAST VALLEY AUTO DRIVE
Second Line	:	SUITE 201
City	:	MESA
State	:	AZ
Zip	:	85206-4605
Country	:	US
Telephone Number	:	602-369-0823
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/MEMBER
Name	:	MR. BRENDON M. HALL
Credential	:	LMP
Telephone Number	:	602-369-0823

Provider Enumeration Date	:	04/01/2011
Last Update Date	:	04/01/2011

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Directions to “HEALTHGAPS, LLC ” Practice Location

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