Provider Demographics
NPI:1932125200
Name:GERSAVA, MARIA DIANE (PT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:DIANE
Last Name:GERSAVA
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:PO BOX 908
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38068-0908
Mailing Address - Country:US
Mailing Address - Phone:901-465-9191
Mailing Address - Fax:901-465-9323
Practice Address - Street 1:7070 HIGHWAY 64
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:TN
Practice Address - Zip Code:38060-3208
Practice Address - Country:US
Practice Address - Phone:901-465-9191
Practice Address - Fax:901-465-9323
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3307225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4042615OtherBCBS PROVIDER NUM
TN4042615OtherBCBS PROVIDER NUM