MEDICARE: KAILEY GLEESON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1801785407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAILEY GLEESON

Provider Business Mailing Address
First Line	:	249 COTTAGE RD
Second Line	:
City	:	VALLEY COTTAGE
State	:	NY
Zip	:	10989-2426
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 LAKE RIDGE PLZ
Second Line	:
City	:	VALLEY COTTAGE
State	:	NY
Zip	:	10989-1925
Country	:	US
Telephone Number	:	845-675-8444
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2025
Last Update Date	:	06/30/2025

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Directions to “ KAILEY GLEESON ” Practice Location

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