Individual
MRS. JOYCE ANNE GANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
266 LINCOLN AVE, SAUGUS, MA 01906-3037
(781) 233-6830
Mailing address
1 DUSTIN ST, SAUGUS, MA 01906-1803
(781) 231-5446
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5040
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0320480
—
MA
01
—
Y68615
MEDICARE PTAN
MA
Enumeration date
11/20/2012
Last updated
11/20/2012
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