Provider Demographics
NPI:1326293267
Name:GUILLEMETTE, GREGORY EDWARD (LMT)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:EDWARD
Last Name:GUILLEMETTE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 S RIVER RD UNIT 21
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6721
Mailing Address - Country:US
Mailing Address - Phone:603-836-5640
Mailing Address - Fax:
Practice Address - Street 1:40 S RIVER RD
Practice Address - Street 2:#21
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6719
Practice Address - Country:US
Practice Address - Phone:603-836-5640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8481225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist