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General NPI Number Information
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NPI Number | 1275031452
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Entity Type | Individual
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Provider Name | PHILIP EARL GERHART LAT ATC
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Gender | Male
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Dates
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Enumeration Date | 01/23/2018
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Last Update Date | 01/23/2018
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Provider Practice Location Address
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Address Line | 820 SIR THOMAS CT
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City | HARRISBURG
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State | PA
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Zip | 17109-4839
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Country | US
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Telephone | 717-724-4870
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Fax |
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Provider Business Mailing Address
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Address Line | 205 AUDREY DR
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City | LITITZ
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State | PA
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Zip | 17543-8726
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | RT006781
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License Number State | PA
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