Provider Demographics
NPI:1396161279
Name:GEROW, LINDY (PTA)
Entity type:Individual
Prefix:
First Name:LINDY
Middle Name:
Last Name:GEROW
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 1:1671 POOLVILLE CUT OFF RD
Mailing Address - Street 2:
Mailing Address - City:POOLVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76487-3639
Mailing Address - Country:US
Mailing Address - Phone:817-845-6458
Mailing Address - Fax:817-523-4705
Practice Address - Street 1:6850 MANHATTAN BLVD
Practice Address - Street 2:STE. 204
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76120-1227
Practice Address - Country:US
Practice Address - Phone:817-507-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-14
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2059703225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant