Provider Demographics
NPI:1376802017
Name:GERSTNER, DONNA K (LMBT)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:K
Last Name:GERSTNER
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 EXPOSITION PL
Mailing Address - Street 2:SUITE 171
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-1560
Mailing Address - Country:US
Mailing Address - Phone:919-601-4328
Mailing Address - Fax:
Practice Address - Street 1:700 EXPOSITION PL
Practice Address - Street 2:SUITE 171
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-1560
Practice Address - Country:US
Practice Address - Phone:919-601-4328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4332225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist