Provider Demographics
NPI:1831796317
Name:SELTZER, KERRY GRILLO (PT)
Entity type:Individual
Prefix:MRS
First Name:KERRY
Middle Name:GRILLO
Last Name:SELTZER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 TRUMBULL RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-2727
Mailing Address - Country:US
Mailing Address - Phone:606-088-1768
Mailing Address - Fax:
Practice Address - Street 1:52 HAZELNUT HILL RD
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-3268
Practice Address - Country:US
Practice Address - Phone:860-446-8265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist