Provider Demographics
NPI:1265084867
Name:GENZLER, MERCADES M (PTA)
Entity type:Individual
Prefix:
First Name:MERCADES
Middle Name:M
Last Name:GENZLER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:GETTYSBURG
Mailing Address - State:SD
Mailing Address - Zip Code:57442-1505
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:920 4TH ST
Practice Address - Street 2:
Practice Address - City:GARRETSON
Practice Address - State:SD
Practice Address - Zip Code:57030-2006
Practice Address - Country:US
Practice Address - Phone:605-594-3466
Practice Address - Fax:605-594-6661
Is Sole Proprietor?:No
Enumeration Date:2019-07-12
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0585225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant