Provider Demographics
NPI:1407321201
Name:LERCHE, FRED FRANKLIN (PT)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:FRANKLIN
Last Name:LERCHE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3534 E SUNSHINE ST STE G
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65809-2815
Mailing Address - Country:US
Mailing Address - Phone:417-731-7094
Mailing Address - Fax:
Practice Address - Street 1:3534 E SUNSHINE ST STE G
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65809-2815
Practice Address - Country:US
Practice Address - Phone:417-731-7094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-08
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist