Provider Demographics
NPI:1578257879
Name:GERCHAK, NICOLLE ADREA (DPT)
Entity Type:Individual
Prefix:
First Name:NICOLLE
Middle Name:ADREA
Last Name:GERCHAK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:NICOLLE
Other - Middle Name:ADREA
Other - Last Name:SEWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3018 W MARINE VIEW DR UNIT B
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-3985
Mailing Address - Country:US
Mailing Address - Phone:509-250-2488
Mailing Address - Fax:
Practice Address - Street 1:10821 19TH AVE SE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-5103
Practice Address - Country:US
Practice Address - Phone:425-225-5865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist