Provider Demographics
NPI:1528091915
Name:GERSAVA, ROLANDO GENTICA (PT)
Entity type:Individual
Prefix:
First Name:ROLANDO
Middle Name:GENTICA
Last Name:GERSAVA
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:PO BOX 908
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38068-0908
Mailing Address - Country:US
Mailing Address - Phone:901-465-1801
Mailing Address - Fax:901-465-1894
Practice Address - Street 1:301 N WEST ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38068-1309
Practice Address - Country:US
Practice Address - Phone:901-465-1801
Practice Address - Fax:901-465-1894
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2685225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3837068OtherAETNA PROVIDER NUM
TNP00158981OtherRAILROAD MEDICARE
TN4086883OtherBCBS PROVIDER NUM
TN3653267Medicare ID - Type Unspecified