Provider Demographics
NPI:1669493938
Name:GELDERMAN, LAURIE M (RPT)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:M
Last Name:GELDERMAN
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
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Mailing Address - Street 1:2 TRAP FALLS RD STE 404
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-7622
Mailing Address - Country:US
Mailing Address - Phone:203-734-7900
Mailing Address - Fax:203-513-3269
Practice Address - Street 1:1275 POST RD SUITE 208
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-6024
Practice Address - Country:US
Practice Address - Phone:203-955-1202
Practice Address - Fax:203-955-1203
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0022962251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT080002296CT01OtherBLUE CROSS/BLUE SHIELD ID
CT20189OtherHEALTH NET
CT20189OtherHEALTH NET