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General NPI Number Information
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NPI Number | 1730809443
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Entity Type | Individual
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Provider Name | KELLY SUE GAYGEN PT
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Gender | Female
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Dates
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Enumeration Date | 09/01/2022
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Last Update Date | 06/16/2025
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Provider Practice Location Address
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Address Line | 397 DAVISON RD
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City | LOCKPORT
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State | NY
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Zip | 14094-4005
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Country | US
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Telephone | 716-266-5252
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Fax | 716-546-2223
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Provider Business Mailing Address
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Address Line | PO BOX 287
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City | GASPORT
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State | NY
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Zip | 14067
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Country | US
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Telephone | 716-255-6262
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 008684-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 8684-01
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License Number State | NY
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