Provider Demographics
NPI:1316092273
Name:ESPIRITU, GERALD (PT)
Entity type:Individual
Prefix:MR
First Name:GERALD
Middle Name:
Last Name:ESPIRITU
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 1:54548 OAK LEAF DR
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-1863
Mailing Address - Country:US
Mailing Address - Phone:574-289-2030
Mailing Address - Fax:
Practice Address - Street 1:1850 PIPESTONE RD STE 202
Practice Address - Street 2:
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-2336
Practice Address - Country:US
Practice Address - Phone:269-925-9491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05003754 A2251G0304X, 2251N0400X, 2251X0800X
MI55010150122251X0800X, 2251S0007X, 2251N0400X, 2251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI 2570001OtherMEDICARE PTAN