Provider Demographics
NPI:1508412016
Name:GEARHART, STEPHEN W (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:W
Last Name:GEARHART
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 E COUNTY LINE RD STE B2
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-2998
Mailing Address - Country:US
Mailing Address - Phone:317-497-6600
Mailing Address - Fax:
Practice Address - Street 1:1030 E COUNTY LINE RD STE B2
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-2998
Practice Address - Country:US
Practice Address - Phone:317-497-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-12
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05013489A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist