Individual provider Active NPI

Brontae Noel Gomes

  • Physical Therapy Assistant
  • Clovis, CA
National Provider Identifier
1457093601
Registry record updated Apr 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
Practice address
2021 Herndon Ave Ste 202
Clovis, CA 93611-6317
Phone
(559) 321-8405
Fax
(559) 900-7952
NPI assigned
Apr 8, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X Primary

Addresses

Primary practice location

2021 Herndon Ave Ste 202
Clovis, CA 93611-6317

Mailing address

7471 N Fresno St
Fresno, CA 93720-2457

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Premium Physical Therapy Inc CurrentSince Apr 10, 2022 Accepting new patients

Locations

2021 Herndon Ave
Ste 202
Clovis, CA 93611
Phone (559) 321-8405

7471 N Fresno St
Fresno, CA 93720
Phone (559) 436-4500

Organizations & group practices 1

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": "1649376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649376000000",
    "number": "1457093601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7471 N FRESNO ST",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937202457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2021 HERNDON AVE STE 202",
            "city": "CLOVIS",
            "state": "CA",
            "postal_code": "936116317",
            "telephone_number": "559-321-8405",
            "fax_number": "559-900-7952"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOMES",
        "first_name": "BRONTAE",
        "middle_name": "NOEL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-08",
        "last_updated": "2022-04-08",
        "certification_date": "2022-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clovis, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.