Provider Demographics
NPI:1215639596
Name:GERSTEL, EVAN SLOAN
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:SLOAN
Last Name:GERSTEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 LAS BRISAS CIR
Mailing Address - Street 2:
Mailing Address - City:HYPOLUXO
Mailing Address - State:FL
Mailing Address - Zip Code:33462-7016
Mailing Address - Country:US
Mailing Address - Phone:561-215-5758
Mailing Address - Fax:
Practice Address - Street 1:15127 S JOG RD STE 210
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-1251
Practice Address - Country:US
Practice Address - Phone:561-498-1098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL29760225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant