Provider Demographics
NPI:1396570529
Name:GERARDI, MESONG ANN (PTA)
Entity type:Individual
Prefix:MS
First Name:MESONG
Middle Name:ANN
Last Name:GERARDI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16601 N 75TH AVE UNIT 2107
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-5041
Mailing Address - Country:US
Mailing Address - Phone:412-965-3266
Mailing Address - Fax:
Practice Address - Street 1:10601 W SANTA FE DR
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3036
Practice Address - Country:US
Practice Address - Phone:623-832-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPTA-014702225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant