Provider Demographics
NPI:1669522124
Name:GERHARDT, PAUL (ATC)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:
Last Name:GERHARDT
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2208 3 OAKS RD
Mailing Address - Street 2:CARY-GROVE HIGH SCHOOL
Mailing Address - City:CARY
Mailing Address - State:IL
Mailing Address - Zip Code:60013-1627
Mailing Address - Country:US
Mailing Address - Phone:847-639-3825
Mailing Address - Fax:
Practice Address - Street 1:2208 3 OAKS RD
Practice Address - Street 2:CARY-GROVE HIGH SCHOOL
Practice Address - City:CARY
Practice Address - State:IL
Practice Address - Zip Code:60013-1627
Practice Address - Country:US
Practice Address - Phone:847-639-3825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer