Provider Demographics
NPI:1720856834
Name:GERGEL, JESSICA STACEY (DPT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:STACEY
Last Name:GERGEL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1504 SW 110TH WAY
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-7194
Mailing Address - Country:US
Mailing Address - Phone:954-593-4436
Mailing Address - Fax:
Practice Address - Street 1:1099 D ST STE 105
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-2839
Practice Address - Country:US
Practice Address - Phone:415-532-8335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-18
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT41089225100000X
CA308323225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist