Provider Demographics
NPI:1629349642
Name:VILLARI, GLORIA BOUCHARD (PT, MT)
Entity Type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:BOUCHARD
Last Name:VILLARI
Suffix:
Gender:F
Credentials:PT, MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 WINTHROP RD
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-2713
Mailing Address - Country:US
Mailing Address - Phone:508-358-6326
Mailing Address - Fax:
Practice Address - Street 1:3 WINTHROP RD
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MA
Practice Address - Zip Code:01778-2713
Practice Address - Country:US
Practice Address - Phone:508-358-6326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3547225100000X
VT040.0003720225100000X
MA1663225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist