Provider Demographics
NPI:1669650859
Name:WEISBROD, GERALD (PT)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:
Last Name:WEISBROD
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 1:6525 WISE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63139-3316
Mailing Address - Country:US
Mailing Address - Phone:314-591-0100
Mailing Address - Fax:636-942-4040
Practice Address - Street 1:7618 OAK CREST CT
Practice Address - Street 2:
Practice Address - City:BARNHART
Practice Address - State:MO
Practice Address - Zip Code:63012-1871
Practice Address - Country:US
Practice Address - Phone:314-604-7449
Practice Address - Fax:636-942-4040
Is Sole Proprietor?:No
Enumeration Date:2008-02-10
Last Update Date:2008-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000167624225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist