Healthcare Provider Details

I. General information

NPI: 1346480001
Provider Name (Legal Business Name): CHRISTOPHER GEORGE DUGRE MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2009
Last Update Date: 02/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 COOPER ST
AGAWAM MA
01001-2149
US

IV. Provider business mailing address

65 COOPER ST
AGAWAM MA
01001-2149
US

V. Phone/Fax

Practice location:
  • Phone: 413-786-8000
  • Fax: 413-306-6401
Mailing address:
  • Phone: 413-786-8000
  • Fax: 413-306-6401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number18439
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: