Provider Demographics
NPI:1295709749
Name:GERLACH, MICHAEL ROBERT (ATC, EMT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ROBERT
Last Name:GERLACH
Suffix:
Gender:M
Credentials:ATC, EMT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1424 DOZIER CT
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7138
Mailing Address - Country:US
Mailing Address - Phone:615-373-8545
Mailing Address - Fax:
Practice Address - Street 1:3901 GRANNY WHITE PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204-3903
Practice Address - Country:US
Practice Address - Phone:615-279-7041
Practice Address - Fax:615-279-5852
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNAT1072255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer