Provider Demographics
NPI:1255502647
Name:GULL, LAURA R (PT)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:R
Last Name:GULL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:R
Other - Last Name:DOSKOCIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:330 MALDEN ST
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:MA
Mailing Address - Zip Code:01520-2112
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15 BELMONT ST
Practice Address - Street 2:UMASS MEMORIAL REHAB GROUP
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2650
Practice Address - Country:US
Practice Address - Phone:508-334-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-13
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18172225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist