Provider Demographics
NPI:1023470218
Name:GILMAN, CONI L (PT)
Entity type:Individual
Prefix:
First Name:CONI
Middle Name:L
Last Name:GILMAN
Suffix:
Gender:F
Credentials:PT
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Mailing Address - Street 1:68 BRADFORD ST
Mailing Address - Street 2:STE K
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-2369
Mailing Address - Country:US
Mailing Address - Phone:413-530-0698
Mailing Address - Fax:888-411-8532
Practice Address - Street 1:68 BRADFORD ST
Practice Address - Street 2:STE K
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2369
Practice Address - Country:US
Practice Address - Phone:413-530-0698
Practice Address - Fax:888-411-8532
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-25
Last Update Date:2017-01-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA15977225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS300355544OtherMEDICARE