Provider Demographics
NPI:1285225656
Name:GERDES, AUNDREA (DPT)
Entity Type:Individual
Prefix:
First Name:AUNDREA
Middle Name:
Last Name:GERDES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:AUNDREA
Other - Middle Name:
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4328 CENTRAL AVE
Mailing Address - Street 2:SUITE M
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913
Mailing Address - Country:US
Mailing Address - Phone:501-701-4343
Mailing Address - Fax:501-701-4207
Practice Address - Street 1:4328 CENTRAL AVE
Practice Address - Street 2:SUITE M
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913
Practice Address - Country:US
Practice Address - Phone:501-701-4343
Practice Address - Fax:501-701-4207
Is Sole Proprietor?:No
Enumeration Date:2021-01-28
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR4801225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR264726721Medicaid