Provider Demographics
NPI:1962942540
Name:GERBRACHT, JILLIAN FAITH (PT)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:FAITH
Last Name:GERBRACHT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 TAAFFE PL
Mailing Address - Street 2:APARTMENT 4L
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-4318
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:209 TAAFFE PL
Practice Address - Street 2:APARTMENT 4L
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-4318
Practice Address - Country:US
Practice Address - Phone:858-401-9443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-02
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT292237225100000X
NY040905225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist