Healthcare Provider Details

I. General information

NPI: 1902576424
Provider Name (Legal Business Name): KATHRYN GAUDETTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2021
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 MEDICAL GROUP UNIT 7095, BOX 185
APO AE
09824
US

IV. Provider business mailing address

39 MEDICAL GROUP UNIT 7095, BOX 185
APO AE
09824
US

V. Phone/Fax

Practice location:
  • Phone: 314-676-7258
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: