Provider Demographics
NPI:1689116949
Name:GYULAVARY, GENEVIEVE ANN (DPT)
Entity Type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:ANN
Last Name:GYULAVARY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 WESTERN BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033
Mailing Address - Country:US
Mailing Address - Phone:860-657-5955
Mailing Address - Fax:860-657-5953
Practice Address - Street 1:320 WESTERN BLVD STE 105
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-1276
Practice Address - Country:US
Practice Address - Phone:860-657-5955
Practice Address - Fax:860-657-5953
Is Sole Proprietor?:No
Enumeration Date:2016-11-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22744225100000X
CT11563225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist