Provider Demographics
NPI:1184198731
Name:GERBER, MATT
Entity Type:Individual
Prefix:MR
First Name:MATT
Middle Name:
Last Name:GERBER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:UPPER CHICHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19014-3409
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:61 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:UPPER CHICHESTER
Practice Address - State:PA
Practice Address - Zip Code:19014-3409
Practice Address - Country:US
Practice Address - Phone:267-991-4527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-16
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA80756015350018653604OtherGROUPE MUTUEL