Kathleen Ryan Gannon, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

002094 Issued in CT

Practice address

500 Chase Pkwy
Waterbury, CT 06708-3346

Phone

(203) 754-2266

Fax

(203) 597-8680

NPI assigned

Jun 26, 2006

Last updated

Jan 11, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Carlson Therapy Network, PC

  dba Carlson Procare

  • Physical Therapist
  • New Milford, CT
  • NPI 1114979226
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1515628800000",
    "number": "1972530186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1377 MOTOR PKWY",
            "address_2": "STE 307",
            "city": "ISLANDIA",
            "state": "NY",
            "postal_code": "117495258",
            "telephone_number": "203-754-2266",
            "fax_number": "203-597-8680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 CHASE PKWY",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067083346",
            "telephone_number": "203-754-2266",
            "fax_number": "203-597-8680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANNON",
        "first_name": "KATHLEEN",
        "middle_name": "RYAN",
        "name_prefix": "Mrs.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-26",
        "last_updated": "2018-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CT",
            "license": "002094",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004203519",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carly Gambardella
• Hannah Gamer, PA-C
• Emily Gammill
• Rupa S Gandhi, LCSW
• Nancy C Gandolfo, RD
• Sarah Gao, M.D.
• Deborah Garber, CNM
• Arlene Marie Garcia, LCSW
• Ilene Garcia
• Izamari Garcia, LCSW

• Physical Therapist in Waterbury, CT
• Providers in Waterbury, CT by specialty
• Physical Therapist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.