Provider Demographics
NPI:1477601912
Name:WILSON-GERARDI, KIM STACY (MSPT)
Entity type:Individual
Prefix:MRS
First Name:KIM
Middle Name:STACY
Last Name:WILSON-GERARDI
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:MS
Other - First Name:KIM
Other - Middle Name:STACY
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:2 INWOOD RD
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06850-1027
Mailing Address - Country:US
Mailing Address - Phone:203-847-8579
Mailing Address - Fax:
Practice Address - Street 1:53 OLD KINGS HWY N STE 103
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-4735
Practice Address - Country:US
Practice Address - Phone:203-656-2229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist