Provider Demographics
NPI:1235273640
Name:DREFAHL, GERALD JOHN (MS,ATC,CSCS)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:JOHN
Last Name:DREFAHL
Suffix:
Gender:M
Credentials:MS,ATC,CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9306 PERKINS RD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-1513
Mailing Address - Country:US
Mailing Address - Phone:225-769-4100
Mailing Address - Fax:
Practice Address - Street 1:9306 PERKINS RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-1513
Practice Address - Country:US
Practice Address - Phone:225-769-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer