Provider Demographics
NPI:1932224714
Name:GAGNON, RAYMOND GERARD (PT)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:GERARD
Last Name:GAGNON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 WASHINGTON ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-1046
Mailing Address - Country:US
Mailing Address - Phone:781-937-9777
Mailing Address - Fax:781-937-9767
Practice Address - Street 1:444 WASHINGTON ST
Practice Address - Street 2:SUITE 401
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-1046
Practice Address - Country:US
Practice Address - Phone:781-937-9777
Practice Address - Fax:781-937-9767
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2010-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4664225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist