Provider Demographics
NPI:1023323540
Name:POPOFF, GAIL (LMT)
Entity type:Individual
Prefix:MS
First Name:GAIL
Middle Name:
Last Name:POPOFF
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 LIBRARY LN
Mailing Address - Street 2:
Mailing Address - City:OLD LYME
Mailing Address - State:CT
Mailing Address - Zip Code:06371-2302
Mailing Address - Country:US
Mailing Address - Phone:860-227-1731
Mailing Address - Fax:860-434-3752
Practice Address - Street 1:8 DAVIS RD W
Practice Address - Street 2:
Practice Address - City:OLD LYME
Practice Address - State:CT
Practice Address - Zip Code:06371-1448
Practice Address - Country:US
Practice Address - Phone:860-227-1731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004522172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist