Individual provider Active NPI

Brooklynn Gumby

  • Physical Therapist
  • Waltham, MA
National Provider Identifier
1356070452
Registry record updated Apr 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
26672 Issued in MA
Practice address
220 Bear Hill Rd Ste 101
Waltham, MA 02451-1004
Phone
(781) 790-8479
NPI assigned
Jun 6, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 26672 MA Primary

Addresses

Primary practice location

220 Bear Hill Rd Ste 101
Waltham, MA 02451-1004

Mailing address

30 Parkside PL Unit 403
Malden, MA 02148-7873
Phone (816) 935-2806

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250124002105 MA Practitioner - Physical Therapist in Private Practice 3072042761 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
26672MAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Concierge Physical Therapy, Inc. CurrentSince Jan 14, 2025 Accepting new patients
Aspire Developmental Services, Inc. Developmental Therapist PastSince Jul 21, 2024 Accepting new patients

Locations

307 Grafton St
Ste 103
Shrewsbury, MA 01545
Phone (508) 841-5037

211 Worcester Providence Tpke
Sutton, MA 01590
Phone (508) 861-1010

211 Worcester Providence Tpke
#T
Sutton, MA 01590

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1654473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744588800000",
    "number": "1356070452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 PARKSIDE PL UNIT 403",
            "city": "MALDEN",
            "state": "MA",
            "postal_code": "021487873",
            "telephone_number": "816-935-2806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 BEAR HILL RD STE 101",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024511004",
            "telephone_number": "781-790-8479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUMBY",
        "first_name": "BROOKLYNN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-06",
        "last_updated": "2025-04-14",
        "certification_date": "2025-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MA",
            "license": "26672",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waltham, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.