Provider Demographics
NPI:1578536769
Name:GERKE, LYNETTE ANNE (PT)
Entity Type:Individual
Prefix:MRS
First Name:LYNETTE
Middle Name:ANNE
Last Name:GERKE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5584 S 115TH ST
Mailing Address - Street 2:
Mailing Address - City:HALES CORNERS
Mailing Address - State:WI
Mailing Address - Zip Code:53130-1812
Mailing Address - Country:US
Mailing Address - Phone:414-469-8728
Mailing Address - Fax:262-780-0717
Practice Address - Street 1:5584 S 115TH ST
Practice Address - Street 2:
Practice Address - City:HALES CORNERS
Practice Address - State:WI
Practice Address - Zip Code:53130-1812
Practice Address - Country:US
Practice Address - Phone:414-469-8728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-09
Last Update Date:2021-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3590-24225100000X
WI3590024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist