Provider Demographics
NPI:1255873964
Name:CONI GILMAN PHYSICAL THERAPY
Entity type:Organization
Organization Name:CONI GILMAN PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CONI
Authorized Official - Middle Name:L
Authorized Official - Last Name:GILMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:413-530-0698
Mailing Address - Street 1:68 BRADFORD ST
Mailing Address - Street 2:SUITE K
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-2537
Mailing Address - Country:US
Mailing Address - Phone:413-530-0698
Mailing Address - Fax:888-411-8532
Practice Address - Street 1:68 BRADFORD ST
Practice Address - Street 2:SUITE K
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2537
Practice Address - Country:US
Practice Address - Phone:413-530-0698
Practice Address - Fax:888-411-8532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-11
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15977225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty