Provider Demographics
NPI:1558411280
Name:GERDING, SAMUEL EDWIN (PT)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:EDWIN
Last Name:GERDING
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:PO BOX 306393
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37230-6393
Mailing Address - Country:US
Mailing Address - Phone:615-373-1350
Mailing Address - Fax:615-221-9054
Practice Address - Street 1:8475 HIGHWAY 6 N STE K
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-2049
Practice Address - Country:US
Practice Address - Phone:281-507-2619
Practice Address - Fax:281-407-3606
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0057722251X0800X
TX1230780225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY005772OtherKY STATE LICENSE
TX1230780OtherTX LICENSE NUMBER