Healthcare Provider Details

I. General information

NPI: 1720856834
Provider Name (Legal Business Name): JESSICA STACEY GERGEL DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2023
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8601 TURNPIKE DR STE 204
WESTMINSTER CO
80031-7044
US

IV. Provider business mailing address

1504 SW 110TH WAY
DAVIE FL
33324-7194
US

V. Phone/Fax

Practice location:
  • Phone: 303-222-4312
  • Fax:
Mailing address:
  • Phone: 954-593-4436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT41089
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number308323
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0021223
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: