Provider Demographics
NPI:1144268020
Name:FENNELL, GAIL P (PT)
Entity type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:P
Last Name:FENNELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:871 ETHAN ALLEN HWY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-2800
Mailing Address - Country:US
Mailing Address - Phone:203-431-0348
Mailing Address - Fax:203-431-0351
Practice Address - Street 1:871 ETHAN ALLEN HWY
Practice Address - Street 2:STE 104
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-2811
Practice Address - Country:US
Practice Address - Phone:203-431-0348
Practice Address - Fax:203-431-0351
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT004216225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist