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NPI Code Detail

MEDICARE: DESERIE GHERARDI P.T.

MEDICARE: DESERIE GHERARDI P.T.
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
1225100000XPhysical Therapist40QA00758400NJ

General Provider Information

NPI Number : 1710940432
Entity Type Code : Individual
Provider Name (Legal Business Name) : DESERIE GHERARDI P.T.
Provider Business Mailing Address
First Line : 5 CARRIAGE WAY
Second Line :
City : HAMMONTON
State : NJ
Zip : 08037-2612
Country : US
Telephone Number : 609-567-7403
Fax Number :
Provider Business Practice Location Address
First Line : 132 W MAIN ST
Second Line :
City : MOORESTOWN
State : NJ
Zip : 08057-2432
Country : US
Telephone Number : 856-234-4397
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/11/2006
Last Update Date : 07/08/2007

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Directions to “ DESERIE GHERARDI P.T.” Practice Location

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