MEDICARE: NICHOLAS J GERLACH PT

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	225100000X	Physical Therapist	T-03323	KS

General Provider Information

NPI Number	:	1487916920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS J GERLACH PT

Provider Business Mailing Address
First Line	:	912 S WHIPPOORWILL RD
Second Line	:
City	:	DERBY
State	:	KS
Zip	:	67037-3626
Country	:	US
Telephone Number	:	316-214-6100
Fax Number	:

Provider Business Practice Location Address
First Line	:	9360 E CENTRAL AVE # S100
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67206-2560
Country	:	US
Telephone Number	:	316-636-4410
Fax Number	:

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

Provider Enumeration Date	:	06/11/2012
Last Update Date	:	06/11/2012

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