Basic Information
Provider Information | |||||||||
NPI: | 1932531472 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | DAUNIS | ||||||||
FirstName: | ABIGAIL | ||||||||
MiddleName: | GORMAN | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | PT, DPT | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | GORMAN | ||||||||
OtherFirstName: | ABIGAIL | ||||||||
OtherMiddleName: | LYNN | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 1180 BEACON ST | ||||||||
Address2: | STE 6C | ||||||||
City: | BROOKLINE | ||||||||
State: | MA | ||||||||
PostalCode: | 024463806 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6177305337 | ||||||||
FaxNumber: | 6177305461 | ||||||||
Practice Location | |||||||||
Address1: | 34 WASHINGTON ST. | ||||||||
Address2: |   | ||||||||
City: | WELLESLEY | ||||||||
State: | MA | ||||||||
PostalCode: | 02481 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7812639993 | ||||||||
FaxNumber: | 7812639996 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/07/2013 | ||||||||
LastUpdateDate: | 06/01/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X |   |   | Y |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   | 225100000X | 21088 | MA | N |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   |
No ID Information.