Provider Demographics
NPI:1164657292
Name:MOGAN, GAIL MARIE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:MARIE
Last Name:MOGAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 ROUTE 6A
Mailing Address - Street 2:2ND FLOOR SUITE
Mailing Address - City:EAST SANDWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02537-1477
Mailing Address - Country:US
Mailing Address - Phone:508-888-8227
Mailing Address - Fax:508-888-8227
Practice Address - Street 1:445 ROUTE 6A
Practice Address - Street 2:2ND FLOOR SUITE
Practice Address - City:EAST SANDWICH
Practice Address - State:MA
Practice Address - Zip Code:02537-1477
Practice Address - Country:US
Practice Address - Phone:508-888-8227
Practice Address - Fax:508-888-8227
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2635172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2635OtherMA BOARD OF MASSAGE THERAPY AS A MASSAGE THERAPIST