Provider Demographics
NPI:1811247968
Name:CACCIABAUDO, GERILYNN (PTA)
Entity type:Individual
Prefix:
First Name:GERILYNN
Middle Name:
Last Name:CACCIABAUDO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 RHINECLIFF RD
Mailing Address - Street 2:
Mailing Address - City:RHINEBECK
Mailing Address - State:NY
Mailing Address - Zip Code:12572-4001
Mailing Address - Country:US
Mailing Address - Phone:845-876-7759
Mailing Address - Fax:
Practice Address - Street 1:168 IRVING AVE
Practice Address - Street 2:SUITE 402A
Practice Address - City:PORT CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10573-4144
Practice Address - Country:US
Practice Address - Phone:914-939-3143
Practice Address - Fax:914-939-3120
Is Sole Proprietor?:No
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0015151225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant