=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982566717
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRANDON GERLE
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/01/2025
-----------------------------------------------------
Last Update Date | 12/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3655 W ANTHEM WAY STE A129
-----------------------------------------------------
City | ANTHEM
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85086-0431
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-847-7050
-----------------------------------------------------
Fax | 480-847-7051
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1650 LYNDON FARM CT STE 300
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40223-5005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 726-202-3039
-----------------------------------------------------
Fax | 210-978-5592
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------