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General NPI Number Information
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NPI Number | 1295709749
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Entity Type | Individual
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Provider Name | MICHAEL ROBERT GERLACH ATC, EMT
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Gender | Male
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Dates
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Enumeration Date | 02/13/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3901 GRANNY WHITE PIKE
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City | NASHVILLE
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State | TN
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Zip | 37204-3903
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Country | US
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Telephone | 615-279-7041
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Fax | 615-279-5852
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Provider Business Mailing Address
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Address Line | 1424 DOZIER CT
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City | BRENTWOOD
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State | TN
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Zip | 37027-7138
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Country | US
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Telephone | 615-373-8545
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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 | AT107
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License Number State | TN
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