MEDICARE: MARISSA GILL DPT, PT

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	20353	MA

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	:	1477891463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISSA GILL DPT, PT

Provider Business Mailing Address
First Line	:	1 CREDIT UNION WAY FL 3
Second Line	:
City	:	RANDOLPH
State	:	MA
Zip	:	02368-4633
Country	:	US
Telephone Number	:	781-961-3370
Fax Number	:	781-961-1291

Provider Business Practice Location Address
First Line	:	375 FAUNCE CORNER RD STE C
Second Line	:
City	:	NORTH DARTMOUTH
State	:	MA
Zip	:	02747-1258
Country	:	US
Telephone Number	:	781-425-7906
Fax Number	:	774-221-2209

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2013
Last Update Date	:	07/24/2019

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