Provider Demographics
NPI:1528008653
Name:GERLACH, ERICA L (MPT)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:L
Last Name:GERLACH
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:L
Other - Last Name:WENGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:420 BAINBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-1568
Mailing Address - Country:US
Mailing Address - Phone:215-629-3837
Mailing Address - Fax:215-629-5531
Practice Address - Street 1:420 BAINBRIDGE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-1568
Practice Address - Country:US
Practice Address - Phone:215-629-3837
Practice Address - Fax:215-629-5531
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT016443174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA071805SAVMedicare PIN