MEDICARE: GAMBARU CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	2251H1300X	Human Factors Physical Therapist
2	2251P0200X	Pediatric Physical Therapist
3	2251S0007X	Sports Physical Therapist
4	2251X0800X	Orthopedic Physical Therapist
5	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053601393
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GAMBARU CORP

Provider Business Mailing Address
First Line	:	999 BROADWAY
Second Line	:	SUITE 100
City	:	SAUGUS
State	:	MA
Zip	:	01906-4521
Country	:	US
Telephone Number	:	781-558-9565
Fax Number	:

Provider Business Practice Location Address
First Line	:	999 BROADWAY
Second Line	:	SUITE 100
City	:	SAUGUS
State	:	MA
Zip	:	01906-4521
Country	:	US
Telephone Number	:	781-558-9565
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DOLORES I KERSHAW
Credential	:	OTR/L
Telephone Number	:	781-558-9565

Provider Enumeration Date	:	04/07/2011
Last Update Date	:	04/07/2011

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Directions to “GAMBARU CORP ” Practice Location

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