Provider Demographics
NPI:1437110582
Name:GHOSTLAW, PAUL M (PT)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:M
Last Name:GHOSTLAW
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 POND AVE
Mailing Address - Street 2:SUITE 107B
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-7163
Mailing Address - Country:US
Mailing Address - Phone:617-232-7246
Mailing Address - Fax:617-232-5196
Practice Address - Street 1:33 POND AVE
Practice Address - Street 2:SUITE 107B
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-7163
Practice Address - Country:US
Practice Address - Phone:617-232-7246
Practice Address - Fax:617-232-5196
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8339225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY68414Medicare ID - Type Unspecified