Provider Demographics
NPI:1952866253
Name:ALFEREZ, GERLOU MAE MARIANO (PT)
Entity Type:Individual
Prefix:
First Name:GERLOU MAE
Middle Name:MARIANO
Last Name:ALFEREZ
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 1:334 CHARLESTON LN APT 109
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-6046
Mailing Address - Country:US
Mailing Address - Phone:931-200-8802
Mailing Address - Fax:
Practice Address - Street 1:55 W LAKE RD
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:TN
Practice Address - Zip Code:38578-3002
Practice Address - Country:US
Practice Address - Phone:931-277-3518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3659225100000X
TN9823225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist