Healthcare Provider Details

I. General information

NPI: 1134328040
Provider Name (Legal Business Name): GEMINI PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 03/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

679 S MAIN ST
HAVERHILL MA
01835-8721
US

IV. Provider business mailing address

679 S MAIN ST
HAVERHILL MA
01835-8721
US

V. Phone/Fax

Practice location:
  • Phone: 978-372-3211
  • Fax:
Mailing address:
  • Phone: 978-372-3211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. CARL WIGHARDT
Title or Position: DIRECTOR
Credential:
Phone: 978-372-3211