Provider Demographics
NPI:1578822821
Name:LERCH, FRED (PT, CNIM)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:
Last Name:LERCH
Suffix:
Gender:M
Credentials:PT, CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 APPLE HOUSE LN
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-3324
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:117 APPLE HOUSE LN
Practice Address - Street 2:STE 501
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-3324
Practice Address - Country:US
Practice Address - Phone:406-241-3588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-07
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT8242251X0800X
246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic