Provider Demographics
NPI:1790318376
Name:GERHARD, BRYAN GREGORY (CPO, LCPO)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:GREGORY
Last Name:GERHARD
Suffix:
Gender:M
Credentials:CPO, LCPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10740 MERIDIAN AVE N STE G2
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-9010
Mailing Address - Country:US
Mailing Address - Phone:206-363-7790
Mailing Address - Fax:206-363-7688
Practice Address - Street 1:10740 MERIDIAN AVE N STE G2
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-9010
Practice Address - Country:US
Practice Address - Phone:206-363-7790
Practice Address - Fax:206-363-7688
Is Sole Proprietor?:No
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist