Provider Demographics
NPI:1073549523
Name:GERKEN, MATTHEW D (ATC)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:D
Last Name:GERKEN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:GORHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04038-1032
Mailing Address - Country:US
Mailing Address - Phone:207-780-5140
Mailing Address - Fax:207-780-5354
Practice Address - Street 1:37 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:ME
Practice Address - Zip Code:04038-1032
Practice Address - Country:US
Practice Address - Phone:207-780-5140
Practice Address - Fax:207-780-5354
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAT1372255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer