Provider Demographics
NPI:1982734778
Name:NEWMAN, GERALD K (PT)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:K
Last Name:NEWMAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:JERRY
Other - Middle Name:
Other - Last Name:NEWMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:902 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FORT MORGAN
Mailing Address - State:CO
Mailing Address - Zip Code:80701-2032
Mailing Address - Country:US
Mailing Address - Phone:970-867-6493
Mailing Address - Fax:970-867-5426
Practice Address - Street 1:902 MAIN ST
Practice Address - Street 2:
Practice Address - City:FORT MORGAN
Practice Address - State:CO
Practice Address - Zip Code:80701-2032
Practice Address - Country:US
Practice Address - Phone:970-867-6493
Practice Address - Fax:970-867-5426
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4453225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist