Provider Demographics
NPI:1649346123
Name:GERSTLE, VIVIAN FRANCES LUU (MSPT)
Entity type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:FRANCES LUU
Last Name:GERSTLE
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:MISS
Other - First Name:VIVIAN
Other - Middle Name:FRANCES
Other - Last Name:LUU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:801 N KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-1513
Mailing Address - Country:US
Mailing Address - Phone:877-407-3422
Mailing Address - Fax:877-407-4329
Practice Address - Street 1:801 N KINGS HWY
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-1513
Practice Address - Country:US
Practice Address - Phone:877-407-3422
Practice Address - Fax:877-407-4329
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPT870268225100000X
VA2305203274225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAN/AOtherRAILROAD MEDICARE PROVIDER NUMBER (MEDICARE PIN)
VA016533F97Medicare PIN