Provider Demographics
NPI:1144307539
Name:GAMMAGE, KELLY ANN (PT)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:GAMMAGE
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 1:146 MIDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-6658
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:155 HILL ST
Practice Address - Street 2:SUITE B
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3192
Practice Address - Country:US
Practice Address - Phone:203-882-9384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4798225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist