Provider Demographics
NPI:1558643676
Name:GERARD, MICHAEL ANTONIO (PT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ANTONIO
Last Name:GERARD
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 1:444 E 58TH ST
Mailing Address - Street 2:APT. 5C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-2327
Mailing Address - Country:US
Mailing Address - Phone:917-324-0105
Mailing Address - Fax:
Practice Address - Street 1:444 E 58TH ST
Practice Address - Street 2:APT. 5C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-2327
Practice Address - Country:US
Practice Address - Phone:917-324-0105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014365-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist