Provider Demographics
NPI:1255614046
Name:GAULIN, DOREEN LYNN (PT)
Entity type:Individual
Prefix:
First Name:DOREEN
Middle Name:LYNN
Last Name:GAULIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GREENLEAF WOODS DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-5437
Mailing Address - Country:US
Mailing Address - Phone:603-319-8334
Mailing Address - Fax:
Practice Address - Street 1:1 GREENLEAF WOODS DR
Practice Address - Street 2:SUITE 101
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-5437
Practice Address - Country:US
Practice Address - Phone:603-319-8334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1944225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHMA RE6358Medicare PIN