Healthcare Provider Details

I. General information

NPI: 1558363440
Provider Name (Legal Business Name): TERESA GEHRT SANBORN RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 08/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 SUNSET AVE.
MANHATTAN KS
66502-3381
US

IV. Provider business mailing address

1823 COLLEGE AVE.
MANHATTAN KS
66502-3381
US

V. Phone/Fax

Practice location:
  • Phone: 785-776-3322
  • Fax:
Mailing address:
  • Phone: 785-776-3322
  • Fax: 785-587-5447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number583
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: