Provider Demographics
NPI:1144623539
Name:GALLANT, DEBORAH
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:GALLANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 N PARK AVE
Mailing Address - Street 2:SUITE 1300
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-4090
Mailing Address - Country:US
Mailing Address - Phone:508-830-0999
Mailing Address - Fax:508-830-0943
Practice Address - Street 1:20 N PARK AVE
Practice Address - Street 2:SUITE 1300
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-4090
Practice Address - Country:US
Practice Address - Phone:508-830-0999
Practice Address - Fax:508-830-0943
Is Sole Proprietor?:No
Enumeration Date:2014-09-30
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5553225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist