Healthcare Provider Details

I. General information

NPI: 1669493938
Provider Name (Legal Business Name): LAURIE M GELDERMAN RPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 01/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 POST RD SUITE 208
FAIRFIELD CT
06824-6024
US

IV. Provider business mailing address

2 TRAP FALLS RD STE 404
SHELTON CT
06484-7622
US

V. Phone/Fax

Practice location:
  • Phone: 203-955-1202
  • Fax: 203-955-1203
Mailing address:
  • Phone: 203-734-7900
  • Fax: 203-513-3269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number002296
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: