Provider Demographics
NPI:1316344922
Name:GELLERMAN, CARLY
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:GELLERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7340 S ALTON WAY
Mailing Address - Street 2:STE 11-D
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-2323
Mailing Address - Country:US
Mailing Address - Phone:720-493-1181
Mailing Address - Fax:720-493-1191
Practice Address - Street 1:42 GEDNEY PARK DR
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-3533
Practice Address - Country:US
Practice Address - Phone:914-582-3612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-25
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15955225100000X
NY038308225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty