=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316374846
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GABRIELLA LETITIA FRITTELLI MSPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/30/2013
-----------------------------------------------------
Last Update Date | 09/30/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 288 NORTHERN PINES RD
-----------------------------------------------------
City | GANSEVOORT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12831-1703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-587-4205
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 288 NORTHERN PINES RD
-----------------------------------------------------
City | GANSEVOORT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12831-1703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-587-4205
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 017980-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------