Healthcare Provider Details

I. General information

NPI: 1336346378
Provider Name (Legal Business Name): BRIAN J GAUER PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1646 5TH AVE N
ESTHERVILLE IA
51334-1760
US

IV. Provider business mailing address

4512 E 42ND ST 313
SIOUX FALLS SD
57110-4431
US

V. Phone/Fax

Practice location:
  • Phone: 712-362-4672
  • Fax:
Mailing address:
  • Phone: 712-209-3443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number01916
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: