Provider Demographics
NPI:1598847964
Name:NEVITT, GERALD DOUGLAS (ATC)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:DOUGLAS
Last Name:NEVITT
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:630 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:GRAND LEDGE
Mailing Address - State:MI
Mailing Address - Zip Code:48837-1402
Mailing Address - Country:US
Mailing Address - Phone:517-614-8497
Mailing Address - Fax:
Practice Address - Street 1:2900 HANNAH BLVD
Practice Address - Street 2:SUITE B-102
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5384
Practice Address - Country:US
Practice Address - Phone:517-364-8050
Practice Address - Fax:517-364-8045
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer