Provider Demographics
NPI:1699764142
Name:GASPARONI, PAULA (PT)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:GASPARONI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:J
Other - Last Name:MULLIGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1342 BELMONT ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-4436
Mailing Address - Country:US
Mailing Address - Phone:508-587-4008
Mailing Address - Fax:508-583-5806
Practice Address - Street 1:1342 BELMONT ST
Practice Address - Street 2:SUITE 102
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4436
Practice Address - Country:US
Practice Address - Phone:508-587-4008
Practice Address - Fax:508-583-5806
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
4665225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0379972Medicaid
MAJ68068Medicare ID - Type Unspecified