Provider Demographics
NPI:1053486282
Name:GELLERT, CHRISTOPHER DAVID (PT, MMUSCSPORTS CSCS)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:DAVID
Last Name:GELLERT
Suffix:
Gender:M
Credentials:PT, MMUSCSPORTS CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:168 INDUSTRIAL DR
Mailing Address - Street 2:
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649-3561
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:123 WATERHOUSE RD
Practice Address - Street 2:
Practice Address - City:BOURNE
Practice Address - State:MA
Practice Address - Zip Code:02532-3890
Practice Address - Country:US
Practice Address - Phone:508-743-7215
Practice Address - Fax:774-247-4397
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA200942251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA021490E71OtherMEDICARE INDIVIDUAL PTAN