Provider Demographics
NPI:1932251196
Name:GERSH, CORY (PT)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:
Last Name:GERSH
Suffix:
Gender:M
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:PO BOX 5924
Mailing Address - Street 2:
Mailing Address - City:CAREFREE
Mailing Address - State:AZ
Mailing Address - Zip Code:85377-5924
Mailing Address - Country:US
Mailing Address - Phone:480-488-9092
Mailing Address - Fax:602-866-3868
Practice Address - Street 1:10000 N 31ST AVE #A102
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-9568
Practice Address - Country:US
Practice Address - Phone:602-866-0066
Practice Address - Fax:602-866-3868
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ773225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ60514Medicare PIN