Provider Demographics
NPI:1811206261
Name:GERLACH, DANIEL R (PTA)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:R
Last Name:GERLACH
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7940 PRESERVE CIR APT 911
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-6747
Mailing Address - Country:US
Mailing Address - Phone:810-357-8145
Mailing Address - Fax:
Practice Address - Street 1:1710 SW HEALTH PKWY
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-0442
Practice Address - Country:US
Practice Address - Phone:239-566-3517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22111225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant