Provider Demographics
NPI:1467574749
Name:GERLACH PHYSICAL THERAPY, PSC
Entity Type:Organization
Organization Name:GERLACH PHYSICAL THERAPY, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:D
Authorized Official - Last Name:GERLACH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:812-734-1784
Mailing Address - Street 1:426 S CAPITOL AVE
Mailing Address - Street 2:
Mailing Address - City:CORYDON
Mailing Address - State:IN
Mailing Address - Zip Code:47112-1014
Mailing Address - Country:US
Mailing Address - Phone:812-734-1784
Mailing Address - Fax:812-734-1784
Practice Address - Street 1:426 S CAPITOL AVE
Practice Address - Street 2:
Practice Address - City:CORYDON
Practice Address - State:IN
Practice Address - Zip Code:47112-1014
Practice Address - Country:US
Practice Address - Phone:812-734-1784
Practice Address - Fax:812-734-1784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN53000084A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200728460Medicaid