Healthcare Provider Details

I. General information

NPI: 1053486282
Provider Name (Legal Business Name): CHRISTOPHER DAVID GELLERT PT, MMUSCSPORTS CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 07/01/2021
Certification Date: 07/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 WATERHOUSE RD
BOURNE MA
02532-3890
US

IV. Provider business mailing address

168 INDUSTRIAL DR
MASHPEE MA
02649-3561
US

V. Phone/Fax

Practice location:
  • Phone: 508-743-7215
  • Fax: 774-247-4397
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number20094
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: