Provider Demographics
NPI:1700919602
Name:GILLETTE, KERRI LEE IALONGO (PT)
Entity Type:Individual
Prefix:MRS
First Name:KERRI
Middle Name:LEE IALONGO
Last Name:GILLETTE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:69 CHESTNUT RD
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-3904
Mailing Address - Country:US
Mailing Address - Phone:401-954-1807
Mailing Address - Fax:401-295-5002
Practice Address - Street 1:38 BROWN ST
Practice Address - Street 2:
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-5039
Practice Address - Country:US
Practice Address - Phone:401-954-1807
Practice Address - Fax:401-295-5002
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI12532251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty