Provider Demographics
NPI:1992035687
Name:VICKERS, GERALD CHRISTOPHER (PT)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:CHRISTOPHER
Last Name:VICKERS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:CHRIS
Other - Middle Name:
Other - Last Name:VICKERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:1336 M 1/2 RD
Mailing Address - Street 2:
Mailing Address - City:LOMA
Mailing Address - State:CO
Mailing Address - Zip Code:81524-9728
Mailing Address - Country:US
Mailing Address - Phone:970-858-1025
Mailing Address - Fax:
Practice Address - Street 1:1336 M 1/2 RD
Practice Address - Street 2:
Practice Address - City:LOMA
Practice Address - State:CO
Practice Address - Zip Code:81524-9728
Practice Address - Country:US
Practice Address - Phone:970-858-1025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-03
Last Update Date:2010-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2974225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist