Provider Demographics
NPI:1407994346
Name:GISMONDI, THOMAS DAMIAN (PT)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:DAMIAN
Last Name:GISMONDI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-2225
Mailing Address - Country:US
Mailing Address - Phone:516-885-3781
Mailing Address - Fax:631-698-7886
Practice Address - Street 1:17 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:SELDEN
Practice Address - State:NY
Practice Address - Zip Code:11784-2225
Practice Address - Country:US
Practice Address - Phone:516-885-3781
Practice Address - Fax:631-698-7886
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006567225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist