Provider Demographics
NPI:1134328040
Name:GEMINI PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:GEMINI PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:WIGHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-372-3211
Mailing Address - Street 1:679 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01835-8721
Mailing Address - Country:US
Mailing Address - Phone:978-372-3211
Mailing Address - Fax:
Practice Address - Street 1:679 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01835-8721
Practice Address - Country:US
Practice Address - Phone:978-372-3211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy