Provider Demographics
NPI:1376753095
Name:PROPFE, GERDT JR (PT)
Entity Type:Individual
Prefix:
First Name:GERDT
Middle Name:
Last Name:PROPFE
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:495 GOLD STAR HWY
Mailing Address - Street 2:SUITE 112
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-6228
Mailing Address - Country:US
Mailing Address - Phone:860-446-8254
Mailing Address - Fax:860-446-8293
Practice Address - Street 1:27 DEPOT ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:CT
Practice Address - Zip Code:06795-2601
Practice Address - Country:US
Practice Address - Phone:860-274-4092
Practice Address - Fax:860-274-4099
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT1847225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT080001847CT02OtherANTHEM BC BS