MEDICARE: THERESE MARIE GERARD 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	PT-372	ID

General Provider Information

NPI Number	:	1962541680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESE MARIE GERARD PT

Provider Business Mailing Address
First Line	:	3906 CATALPA DR
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83703-4258
Country	:	US
Telephone Number	:	208-344-7913
Fax Number	:

Provider Business Practice Location Address
First Line	:	9490 FAIRVIEW AVE
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83704-8101
Country	:	US
Telephone Number	:	208-322-7061
Fax Number	:	208-321-7052

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

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	01/28/2008

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Directions to “ THERESE MARIE GERARD PT” Practice Location

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