=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902887326
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KELLY MARIE GIGLIO M.S.P.T.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/11/2005
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2 DELAVERGNE AVE C/O CENTER FOR PHYSICAL THERAPY
-----------------------------------------------------
City | WAPPINGERS FALLS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12590-1202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-297-4789
-----------------------------------------------------
Fax | 845-297-8596
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 DELAVERGNE AVE C/O CENTER FOR PHYSICAL THERAPY
-----------------------------------------------------
City | WAPPINGERS FALLS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12590-1202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-297-4789
-----------------------------------------------------
Fax | 845-297-8596
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251P0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Physical Therapist
-----------------------------------------------------
License Number | 022350
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------