Provider Demographics
NPI:1083837009
Name:GERLACH, HEATHER D (PT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:D
Last Name:GERLACH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 S CAPITOL AVE
Mailing Address - Street 2:
Mailing Address - City:CORYDON
Mailing Address - State:IN
Mailing Address - Zip Code:47112-1014
Mailing Address - Country:US
Mailing Address - Phone:812-734-1784
Mailing Address - Fax:812-734-1784
Practice Address - Street 1:426 S CAPITOL AVE
Practice Address - Street 2:
Practice Address - City:CORYDON
Practice Address - State:IN
Practice Address - Zip Code:47112-1014
Practice Address - Country:US
Practice Address - Phone:812-734-1784
Practice Address - Fax:812-734-1784
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05007041A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200671420Medicaid
IN200447490AMedicaid
IN193920GMedicare UPIN