Provider Demographics
NPI:1861652166
Name:GERLOFF, BENJAMIN ALAN (PT)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:ALAN
Last Name:GERLOFF
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:N4308 COUNTY RD E
Mailing Address - Street 2:
Mailing Address - City:PINE RIVER
Mailing Address - State:WI
Mailing Address - Zip Code:54965-7504
Mailing Address - Country:US
Mailing Address - Phone:920-229-0567
Mailing Address - Fax:
Practice Address - Street 1:601 GROVE AVE
Practice Address - Street 2:
Practice Address - City:WILD ROSE
Practice Address - State:WI
Practice Address - Zip Code:54984-6903
Practice Address - Country:US
Practice Address - Phone:920-622-5595
Practice Address - Fax:920-622-5594
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9501-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist