Provider Demographics
NPI:1922240720
Name:ADILLE, GERARDO INIGO (RPT)
Entity Type:Individual
Prefix:
First Name:GERARDO
Middle Name:INIGO
Last Name:ADILLE
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 BLIVEN ST
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-3502
Mailing Address - Country:US
Mailing Address - Phone:860-446-2830
Mailing Address - Fax:
Practice Address - Street 1:3 S WIG HILL RD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:CT
Practice Address - Zip Code:06412-1106
Practice Address - Country:US
Practice Address - Phone:860-526-5316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-26
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007662225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist