Provider Demographics
NPI:1710559810
Name:GILLOOLY, CHRISTIN WEBSTER (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:CHRISTIN
Middle Name:WEBSTER
Last Name:GILLOOLY
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 WALNUT ST BLDG 3
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-2108
Mailing Address - Country:US
Mailing Address - Phone:781-239-0100
Mailing Address - Fax:781-239-0102
Practice Address - Street 1:10 TECH CIR
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-1029
Practice Address - Country:US
Practice Address - Phone:781-239-0100
Practice Address - Fax:781-239-0102
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9313225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist