Individual
MRS. KATHLEEN RYAN GANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
500 CHASE PKWY, WATERBURY, CT 06708-3346
(203) 754-2266
(203) 597-8680
Mailing address
1377 MOTOR PKWY, STE 307, ISLANDIA, NY 11749-5258
(203) 754-2266
(203) 597-8680
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
002094
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004203519
—
CT
Enumeration date
06/26/2006
Last updated
01/11/2018
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