Provider Demographics
NPI:1275785008
Name:GERBERICK-DOUGLASS, EMILY A (LMT)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:A
Last Name:GERBERICK-DOUGLASS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:A
Other - Last Name:GERBERICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:110 N POPLAR ST
Mailing Address - Street 2:5151 MORNING SUN ROAD, SUITE B
Mailing Address - City:OXFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45056-1204
Mailing Address - Country:US
Mailing Address - Phone:513-593-8275
Mailing Address - Fax:513-524-5424
Practice Address - Street 1:110 N POPLAR ST
Practice Address - Street 2:5151 MORNING SUN ROAD, SUITE B
Practice Address - City:OXFORD
Practice Address - State:OH
Practice Address - Zip Code:45056-1204
Practice Address - Country:US
Practice Address - Phone:513-593-8275
Practice Address - Fax:513-524-5424
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-10
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH12457174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist