Provider Demographics
NPI:1992902324
Name:GERKIN, AUDRA KATE (PTA)
Entity type:Individual
Prefix:
First Name:AUDRA
Middle Name:KATE
Last Name:GERKIN
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 1:745 THOMPSON LN
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:IN
Mailing Address - Zip Code:47446-5401
Mailing Address - Country:US
Mailing Address - Phone:812-889-4681
Mailing Address - Fax:
Practice Address - Street 1:900 ANSON ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:IN
Practice Address - Zip Code:47167-1982
Practice Address - Country:US
Practice Address - Phone:812-883-4681
Practice Address - Fax:812-883-8113
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06002970A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant