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NPI Code Detail

MEDICARE: CAROLE GILLIS DPT

MEDICARE: CAROLE GILLIS DPT
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
1225100000XPhysical Therapist20854MA

General Provider Information

NPI Number : 1831513340
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAROLE GILLIS DPT
Provider Business Mailing Address
First Line : 535 S MAIN ST
Second Line :
City : RANDOLPH
State : MA
Zip : 02368-5261
Country : US
Telephone Number : 781-961-3370
Fax Number : 781-767-7531
Provider Business Practice Location Address
First Line : 1350 TREMONT ST
Second Line :
City : BOSTON
State : MA
Zip : 02120-3447
Country : US
Telephone Number : 617-267-3773
Fax Number : 617-602-1010
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/05/2014
Last Update Date : 02/05/2014

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Directions to “ CAROLE GILLIS DPT” Practice Location

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