MEDICARE: LEIGH GERDES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	0975	SD

General Provider Information

NPI Number	:	1518187939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEIGH GERDES

Provider Business Mailing Address
First Line	:	2710 W 12TH ST
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57104-3701
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2710 W 12TH ST
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57104-3701
Country	:	US
Telephone Number	:	605-328-5900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	01/22/2013

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Directions to “ LEIGH GERDES ” Practice Location

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