Provider Demographics
NPI:1568895928
Name:GORHAM, ALICIA BURILLO (DPT)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:BURILLO
Last Name:GORHAM
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:JEAN
Other - Last Name:BURILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 CREDIT UNION WAY FL 3
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-4633
Mailing Address - Country:US
Mailing Address - Phone:781-961-3370
Mailing Address - Fax:781-961-1291
Practice Address - Street 1:156 ANDOVER ST UNIT 2
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-1468
Practice Address - Country:US
Practice Address - Phone:978-767-8343
Practice Address - Fax:978-767-8349
Is Sole Proprietor?:No
Enumeration Date:2013-08-20
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0361401225100000X
MA21382225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1233079OtherAMERICAN SPECIALTY HEALTH (ASHCIGNA)
MA233423OtherTUFTS HEALTH PLANS- COMMERCIAL PLANS
MA4731307OtherAETNA
MA877138OtherOPTUM/UNITED HEALTH CARE
MA110110058AMedicaid