Healthcare Provider Details

I. General information

NPI: 1215639596
Provider Name (Legal Business Name): EVAN SLOAN GERSTEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15127 S JOG RD STE 210
DELRAY BEACH FL
33446-1251
US

IV. Provider business mailing address

147 LAS BRISAS CIR
HYPOLUXO FL
33462-7016
US

V. Phone/Fax

Practice location:
  • Phone: 561-498-1098
  • Fax:
Mailing address:
  • Phone: 561-215-5758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number29760
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: