Provider Demographics
NPI:1881636504
Name:GERSTMYER, LISA A (PT)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:A
Last Name:GERSTMYER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 MONMOUTH PKWY
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH BEACH
Mailing Address - State:NJ
Mailing Address - Zip Code:07750-1130
Mailing Address - Country:US
Mailing Address - Phone:732-693-1779
Mailing Address - Fax:732-229-4342
Practice Address - Street 1:1041 STATE ROUTE 36
Practice Address - Street 2:
Practice Address - City:ATLANTIC HIGHLANDS
Practice Address - State:NJ
Practice Address - Zip Code:07716-2533
Practice Address - Country:US
Practice Address - Phone:732-693-1779
Practice Address - Fax:732-229-4342
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ07221225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ038199VFCMedicare ID - Type UnspecifiedINDIVIDUAL MEDICARE #