Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 20094 | MA |
NPI | 1053486282 |
---|---|
Provider Name | Christopher David Gellert |
First Address | Mashpee, MA 02649-3561 |
Second Address | Bourne, MA 02532-3890 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2006 |
Last Update Date | 01/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
021490E71 | MEDICARE INDIVIDUAL PTAN (01) | MA |