Healthcare Provider Details

I. General information

NPI: 1811206261
Provider Name (Legal Business Name): DANIEL R GERLACH PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2010
Last Update Date: 10/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 SW HEALTH PKWY
NAPLES FL
34109-0442
US

IV. Provider business mailing address

7940 PRESERVE CIR APT 911
NAPLES FL
34119-6747
US

V. Phone/Fax

Practice location:
  • Phone: 239-566-3517
  • Fax:
Mailing address:
  • Phone: 810-357-8145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number22111
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: