Provider Demographics
NPI:1952557761
Name:MCKEAN-GERBIN, GEORGETTE LYNN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:GEORGETTE
Middle Name:LYNN
Last Name:MCKEAN-GERBIN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MRS
Other - First Name:GEORGETTE
Other - Middle Name:LYNN
Other - Last Name:MCKEAN GERBIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:600 SOUTH WILBUR AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204
Mailing Address - Country:US
Mailing Address - Phone:315-476-7441
Mailing Address - Fax:
Practice Address - Street 1:7041 MANLIUS CENTER RD
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057
Practice Address - Country:US
Practice Address - Phone:315-579-5610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0063401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist