Provider Demographics
NPI:1174916977
Name:GAGLIONE, GERALD A (ATC, LAT)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:A
Last Name:GAGLIONE
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 EAST ST
Mailing Address - Street 2:APT 161
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-5406
Mailing Address - Country:US
Mailing Address - Phone:781-983-9083
Mailing Address - Fax:
Practice Address - Street 1:171 EAST ST
Practice Address - Street 2:APT 161
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-5406
Practice Address - Country:US
Practice Address - Phone:781-983-9083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-18
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22802255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer