Provider Demographics
NPI:1023447265
Name:FREDERICK, GERALD (PT)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:
Last Name:FREDERICK
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 1:3200 GRANDE OAK PL
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-1208
Mailing Address - Country:US
Mailing Address - Phone:717-285-3723
Mailing Address - Fax:717-285-3723
Practice Address - Street 1:3200 GRANDE OAK PL
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-1208
Practice Address - Country:US
Practice Address - Phone:717-285-3723
Practice Address - Fax:717-285-3723
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT002344L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist