Provider Demographics
NPI:1639111875
Name:GERIK, SUSAN MARIE
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIE
Last Name:GERIK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 CONCORD PLAZA DR
Mailing Address - Street 2:130
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-6905
Mailing Address - Country:US
Mailing Address - Phone:210-804-5530
Mailing Address - Fax:210-804-5501
Practice Address - Street 1:400 CONCORD PLAZA DR
Practice Address - Street 2:130
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-6905
Practice Address - Country:US
Practice Address - Phone:210-804-5530
Practice Address - Fax:210-804-5501
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102137225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3754157OtherAETNA
TX5092734OtherCIGNA
TX8T3235OtherBCBS
TXQ36561Medicare UPIN
TX3754157OtherAETNA