Provider Demographics
NPI:1205564002
Name:GALLINOT, GUSTAVE ROBERT (DPT)
Entity type:Individual
Prefix:
First Name:GUSTAVE
Middle Name:ROBERT
Last Name:GALLINOT
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:STAATS PHYSICAL THERAPY
Mailing Address - Street 2:489 BRICK BOULEVARD
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723
Mailing Address - Country:US
Mailing Address - Phone:732-920-0880
Mailing Address - Fax:
Practice Address - Street 1:STAATS PHYSICAL THERAPY
Practice Address - Street 2:489 BRICK BOULEVARD
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723
Practice Address - Country:US
Practice Address - Phone:732-920-0880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02099900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist