Healthcare Provider Details

I. General information

NPI: 1972938777
Provider Name (Legal Business Name): JONATHAN PAUL GERALDS P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2013
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 OAKDALE DR UNIT 8
HILLSBOROUGH NC
27278-9080
US

IV. Provider business mailing address

12508 JONES MALTSBERGER RD STE 110
SAN ANTONIO TX
78247-4214
US

V. Phone/Fax

Practice location:
  • Phone: 919-732-6600
  • Fax: 919-732-2779
Mailing address:
  • Phone: 888-590-4002
  • Fax: 210-590-4585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number60342
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1283349
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP-CP029548T
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: