Provider Demographics
NPI:1205440336
Name:GEHLERT, KAREN J
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:J
Last Name:GEHLERT
Suffix:
Gender:F
Credentials:
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 51742
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85208-0088
Mailing Address - Country:US
Mailing Address - Phone:920-540-5266
Mailing Address - Fax:
Practice Address - Street 1:20522 E SUPERSTITION DR
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-9763
Practice Address - Country:US
Practice Address - Phone:602-421-7718
Practice Address - Fax:480-240-1290
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-05
Last Update Date:2020-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1830225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist