Basic Information
| Provider Information | |||||||||
| NPI: | 1316344922 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GELLERMAN | ||||||||
| FirstName: | CARLY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7340 S ALTON WAY | ||||||||
| Address2: | STE 11-D | ||||||||
| City: | CENTENNIAL | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801122323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7204931181 | ||||||||
| FaxNumber: | 7204931191 | ||||||||
| Practice Location | |||||||||
| Address1: | 42 GEDNEY PARK DR | ||||||||
| Address2: | |||||||||
| City: | WHITE PLAINS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 106053533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9145823612 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/25/2014 | ||||||||
| LastUpdateDate: | 10/12/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 15955 | CO | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 038308 | NY | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.