Provider Demographics
NPI:1386268886
Name:GERSON, LEVI
Entity type:Individual
Prefix:
First Name:LEVI
Middle Name:
Last Name:GERSON
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 1:14085 DENVER WEST CIR APT 2407
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80401-3331
Mailing Address - Country:US
Mailing Address - Phone:913-787-2504
Mailing Address - Fax:
Practice Address - Street 1:400 INDIANA ST STE 340
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-5033
Practice Address - Country:US
Practice Address - Phone:720-452-1267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-01
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00169682251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic