Provider Demographics
NPI:1972630069
Name:GERARD, MELISSA E (PT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:E
Last Name:GERARD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7100 W CENTER RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-2714
Mailing Address - Country:US
Mailing Address - Phone:402-506-9127
Mailing Address - Fax:402-315-2707
Practice Address - Street 1:2728 N 108TH ST STE 103
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-3763
Practice Address - Country:US
Practice Address - Phone:402-939-7939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03968225100000X
NE2292225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025941700Medicaid
NE10026026700Medicaid
IA1972630069Medicaid
NE10025895900Medicaid
NE10026252200Medicaid
NE2292OtherSTATE LICENSE NUMBER
NE1026445500Medicaid
NE10025896000Medicaid
NE10025896100Medicaid
IA03968OtherSTATE LICENSE NUMBER
NE10026026700Medicaid