Provider Demographics
NPI:1902527740
Name:GANTERT, TRICIA B (PT)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:B
Last Name:GANTERT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 OLD BRIDGE RD E
Mailing Address - Street 2:
Mailing Address - City:NEW FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06812-3211
Mailing Address - Country:US
Mailing Address - Phone:203-470-6066
Mailing Address - Fax:
Practice Address - Street 1:27 GOVERNOR ST
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-4608
Practice Address - Country:US
Practice Address - Phone:203-438-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-09
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004963225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist