Provider Demographics
NPI:1760807291
Name:GERLT, TODD (ATC)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:
Last Name:GERLT
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:OKLAHOMA STATE UNIVERSITY
Mailing Address - Street 2:170 D ATHLETICS CENTER
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74078-0001
Mailing Address - Country:US
Mailing Address - Phone:405-744-7416
Mailing Address - Fax:405-744-4945
Practice Address - Street 1:OKLAHOMA STATE UNIVERSITY
Practice Address - Street 2:170 D ATHLETICS CENTER
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74078-0001
Practice Address - Country:US
Practice Address - Phone:405-744-7416
Practice Address - Fax:405-744-4945
Is Sole Proprietor?:No
Enumeration Date:2014-02-20
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer