=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528008653
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERICA L. GERLACH M.P.T.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/07/2006
-----------------------------------------------------
Last Update Date | 04/15/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 420 BAINBRIDGE ST
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19147-1568
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-629-3837
-----------------------------------------------------
Fax | 215-629-5531
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 420 BAINBRIDGE ST
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19147-1568
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-629-3837
-----------------------------------------------------
Fax | 215-629-5531
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | PT016443
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------