Provider Demographics
NPI:1952632713
Name:GERBER, MIRIAM C (MA 35798)
Entity Type:Individual
Prefix:MS
First Name:MIRIAM
Middle Name:C
Last Name:GERBER
Suffix:
Gender:F
Credentials:MA 35798
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 RUSTIC LN
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-2968
Mailing Address - Country:US
Mailing Address - Phone:610-296-3690
Mailing Address - Fax:
Practice Address - Street 1:8 RUSTIC LN
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-2968
Practice Address - Country:US
Practice Address - Phone:610-296-3690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-19
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 35798225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist