Provider Demographics
NPI:1336930387
Name:GAY, LOUISDOR JR (CO-OWNER)
Entity type:Individual
Prefix:
First Name:LOUISDOR
Middle Name:
Last Name:GAY
Suffix:JR
Gender:M
Credentials:CO-OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 LEGION PKWY STE 26
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-7225
Mailing Address - Country:US
Mailing Address - Phone:508-409-0489
Mailing Address - Fax:
Practice Address - Street 1:71 LEGION PKWY STE 26
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-7225
Practice Address - Country:US
Practice Address - Phone:508-409-0489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach