Provider Demographics
NPI:1871077636
Name:CLANCEY, BRIAN THOMAS (PT, DPT)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:THOMAS
Last Name:CLANCEY
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1644 CONCORD ST STE 1
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-3613
Mailing Address - Country:US
Mailing Address - Phone:617-634-2607
Mailing Address - Fax:617-634-5733
Practice Address - Street 1:1644 CONCORD ST STE 1
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-3613
Practice Address - Country:US
Practice Address - Phone:617-634-2607
Practice Address - Fax:617-634-5733
Is Sole Proprietor?:No
Enumeration Date:2018-09-18
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA23760225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist