Provider Demographics
NPI:1619415759
Name:GIASULLO, SARAH (PHD, ATC, CMPC, CSCS)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:GIASULLO
Suffix:
Gender:F
Credentials:PHD, ATC, CMPC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1844 COMMONWEALTH AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02466-2709
Mailing Address - Country:US
Mailing Address - Phone:617-243-2431
Mailing Address - Fax:
Practice Address - Street 1:10 STACEY RD
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:MA
Practice Address - Zip Code:02359-3415
Practice Address - Country:US
Practice Address - Phone:781-500-9082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-09
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT101093172255A2300X
MA28402255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer