Provider Demographics
NPI:1841900131
Name:GAUDET, EDWARD ALBERT (DPT)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:ALBERT
Last Name:GAUDET
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:14 SUNNYSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01543-1747
Mailing Address - Country:US
Mailing Address - Phone:541-973-1677
Mailing Address - Fax:
Practice Address - Street 1:44 RIVULET ST
Practice Address - Street 2:
Practice Address - City:UXBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01569-3134
Practice Address - Country:US
Practice Address - Phone:508-278-2002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-29
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA265432251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA26543Other14587428807