Healthcare Provider Details

I. General information

NPI: 1134402522
Provider Name (Legal Business Name): JOAN H GERTZ PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2011
Last Update Date: 09/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 RUCCIO WAY STE 190
LEXINGTON KY
40503-3566
US

IV. Provider business mailing address

261 RUCCIO WAY STE 190
LEXINGTON KY
40503-3566
US

V. Phone/Fax

Practice location:
  • Phone: 859-266-0404
  • Fax: 859-266-0621
Mailing address:
  • Phone: 859-266-0404
  • Fax: 859-266-0621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number000658
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: