Provider Demographics
NPI:1639353824
Name:GILSON, DANIEL J (MPT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:GILSON
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 MULE RD
Mailing Address - Street 2:SUITE E-2
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-5043
Mailing Address - Country:US
Mailing Address - Phone:732-473-1666
Mailing Address - Fax:732-473-1601
Practice Address - Street 1:823 LACEY RD
Practice Address - Street 2:
Practice Address - City:FORKED RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08731-1203
Practice Address - Country:US
Practice Address - Phone:609-693-5050
Practice Address - Fax:609-693-0222
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01039000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ069713UNEMedicare UPIN
NJ094914Medicare PIN