Provider Demographics
NPI:1134679756
Name:KEPHART, GERALD (PT, DPT)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:
Last Name:KEPHART
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 NAPOLI DR
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-4024
Mailing Address - Country:US
Mailing Address - Phone:714-321-8692
Mailing Address - Fax:
Practice Address - Street 1:242 NAPOLI DR
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-4024
Practice Address - Country:US
Practice Address - Phone:714-321-8692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-06
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40923225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist