Provider Demographics
NPI:1851954739
Name:GERARDI, MARIO MANUEL
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:MANUEL
Last Name:GERARDI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 NE 20TH ST APT 137D
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-8039
Mailing Address - Country:US
Mailing Address - Phone:772-618-3688
Mailing Address - Fax:
Practice Address - Street 1:1730 S FEDERAL HWY # 268
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-3309
Practice Address - Country:US
Practice Address - Phone:305-305-6367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-17
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist