Provider Demographics
NPI:1336464486
Name:GUERCIO, GERI LYNN VANDENBERG (PT)
Entity Type:Individual
Prefix:
First Name:GERI
Middle Name:LYNN VANDENBERG
Last Name:GUERCIO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 NW BENGAL ST
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-5392
Mailing Address - Country:US
Mailing Address - Phone:772-323-8597
Mailing Address - Fax:
Practice Address - Street 1:5200 NW BENGAL ST
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-5392
Practice Address - Country:US
Practice Address - Phone:772-323-8597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-01
Last Update Date:2014-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT24238225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004646600Medicaid