MEDICARE: LINDY GEROW PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	2059703	TX

General Provider Information

NPI Number	:	1396161279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDY GEROW PTA

Provider Business Mailing Address
First Line	:	1671 POOLVILLE CUT OFF RD
Second Line	:
City	:	POOLVILLE
State	:	TX
Zip	:	76487-3639
Country	:	US
Telephone Number	:	817-845-6458
Fax Number	:	817-523-4705

Provider Business Practice Location Address
First Line	:	6850 MANHATTAN BLVD
Second Line	:	STE. 204
City	:	FORT WORTH
State	:	TX
Zip	:	76120-1227
Country	:	US
Telephone Number	:	817-507-1500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2014
Last Update Date	:	03/14/2014

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