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General NPI Number Information
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NPI Number | 1275753469
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Entity Type | Individual
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Provider Name | LANCE DEREK GERBER PT, DPT, OCS
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Gender | Male
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Dates
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Enumeration Date | 04/27/2007
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Last Update Date | 03/29/2011
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Provider Practice Location Address
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Address Line | 315 N 14TH AVE PHYSICAL THERAPY
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City | OTHELLO
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State | WA
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Zip | 99344-1254
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Country | US
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Telephone | 509-331-2641
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Fax |
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Provider Business Mailing Address
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Address Line | 315 N 14TH AVE PHYSICAL THERAPY
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City | OTHELLO
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State | WA
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Zip | 99344-1254
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT 00008041
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License Number State | WA
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