Provider Demographics
NPI:1730892597
Name:GERDIN, ELIZABETH (ATC, LAT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:GERDIN
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:NORTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC, LAT
Mailing Address - Street 1:21313 OLD LAKE GEORGE BLVD
Mailing Address - Street 2:
Mailing Address - City:OAK GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55303-8957
Mailing Address - Country:US
Mailing Address - Phone:651-353-2394
Mailing Address - Fax:
Practice Address - Street 1:15700 37TH AVE N STE 150
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55446-3675
Practice Address - Country:US
Practice Address - Phone:651-968-1627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-26
Last Update Date:2022-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer