Provider Demographics
NPI:1134402522
Name:GERTZ, JOAN H (PT)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:H
Last Name:GERTZ
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 1:261 RUCCIO WAY STE 190
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-3566
Mailing Address - Country:US
Mailing Address - Phone:859-266-0404
Mailing Address - Fax:859-266-0621
Practice Address - Street 1:261 RUCCIO WAY STE 190
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3566
Practice Address - Country:US
Practice Address - Phone:859-266-0404
Practice Address - Fax:859-266-0621
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY000658225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist