Provider Demographics
NPI:1114940384
Name:GERRISH, ALISSON L (PT, MS, CSCS)
Entity Type:Individual
Prefix:
First Name:ALISSON
Middle Name:L
Last Name:GERRISH
Suffix:
Gender:F
Credentials:PT, MS, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 DONNA DR
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02339-2212
Mailing Address - Country:US
Mailing Address - Phone:617-291-2155
Mailing Address - Fax:
Practice Address - Street 1:247 W CENTRAL ST
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-3714
Practice Address - Country:US
Practice Address - Phone:508-647-1633
Practice Address - Fax:508-647-1634
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16985225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist