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General NPI Number Information
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NPI Number | 1992115992
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Entity Type | Individual
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Provider Name | NICHOLAS GELLER ATC
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Gender | Male
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Dates
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Enumeration Date | 04/30/2014
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Last Update Date | 04/30/2014
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Provider Practice Location Address
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Address Line | 282 FARMERS ROW
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City | GROTON
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State | MA
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Zip | 01450-1848
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Country | US
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Telephone | 978-448-7532
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Fax |
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Provider Business Mailing Address
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Address Line | 1 DAYBROOK DR APT 314
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City | AYER
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State | MA
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Zip | 01432-1730
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Country | US
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Telephone | 802-299-7257
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2291
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License Number State | MA
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