Provider Demographics
NPI:1326404906
Name:GILDON, EARNEST (LMT)
Entity Type:Individual
Prefix:MR
First Name:EARNEST
Middle Name:
Last Name:GILDON
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 1:5 PARK VALE
Mailing Address - Street 2:APT 4C
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-6228
Mailing Address - Country:US
Mailing Address - Phone:617-596-3429
Mailing Address - Fax:
Practice Address - Street 1:5 PARK VALE
Practice Address - Street 2:APT 4C
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-6228
Practice Address - Country:US
Practice Address - Phone:617-596-3429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-12
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMT-10217-MT225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist