Provider Demographics
NPI:1275753469
Name:GERBER, LANCE DEREK (PT, DPT, OCS)
Entity Type:Individual
Prefix:MR
First Name:LANCE
Middle Name:DEREK
Last Name:GERBER
Suffix:
Gender:M
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 N 14TH AVE
Mailing Address - Street 2:PHYSICAL THERAPY
Mailing Address - City:OTHELLO
Mailing Address - State:WA
Mailing Address - Zip Code:99344-1254
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:315 N 14TH AVE
Practice Address - Street 2:PHYSICAL THERAPY
Practice Address - City:OTHELLO
Practice Address - State:WA
Practice Address - Zip Code:99344-1254
Practice Address - Country:US
Practice Address - Phone:509-331-2641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT 000080412251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic