Provider Demographics
NPI:1518312594
Name:GALLANT, ELIZABETH (LMT)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:
Last Name:GALLANT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MISS
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:CLAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:939 SALEM ST
Mailing Address - Street 2:UNIT 4
Mailing Address - City:GROVELAND
Mailing Address - State:MA
Mailing Address - Zip Code:01834-1565
Mailing Address - Country:US
Mailing Address - Phone:978-352-7677
Mailing Address - Fax:
Practice Address - Street 1:939 SALEM ST
Practice Address - Street 2:UNIT 4
Practice Address - City:GROVELAND
Practice Address - State:MA
Practice Address - Zip Code:01834-1565
Practice Address - Country:US
Practice Address - Phone:978-352-7677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11932225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist