Provider Demographics
NPI:1922670447
Name:BOISSELLE, KRISTEN MARIE GAGNON (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:MARIE GAGNON
Last Name:BOISSELLE
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-3276
Mailing Address - Country:US
Mailing Address - Phone:978-906-0631
Mailing Address - Fax:
Practice Address - Street 1:54 WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-3276
Practice Address - Country:US
Practice Address - Phone:978-906-0631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16407225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist