Basic Information
| Provider Information | |||||||||
| NPI: | 1639727928 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MORENO | ||||||||
| FirstName: | GABRIELE | ||||||||
| MiddleName: | TAWNEY | ||||||||
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| Credential: | DPT | ||||||||
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| OtherLastName: | MORENO | ||||||||
| OtherFirstName: | GABBY | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 20 FELTON ST APT 101 | ||||||||
| Address2: | |||||||||
| City: | HUDSON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017492161 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4436034817 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 904C BOSTON TPKE | ||||||||
| Address2: | |||||||||
| City: | SHREWSBURY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 015453303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088453500 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2019 | ||||||||
| LastUpdateDate: | 08/29/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2305213145 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.