Provider Demographics
NPI:1538153143
Name:ROBERTS, GAIL MANDEL (PT)
Entity type:Individual
Prefix:MS
First Name:GAIL
Middle Name:MANDEL
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1509
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-0012
Mailing Address - Country:US
Mailing Address - Phone:617-731-1809
Mailing Address - Fax:617-731-1809
Practice Address - Street 1:14 LINDEN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-7885
Practice Address - Country:US
Practice Address - Phone:617-731-1809
Practice Address - Fax:617-731-1809
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2173225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY65181Medicare ID - Type UnspecifiedPHYSICAL THERAPIST