Provider Demographics
NPI:1861766800
Name:GERTON, ELIZABETH A
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:GERTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ANNE
Other - Last Name:KENNARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1046 AL TAHOE BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-4603
Mailing Address - Country:US
Mailing Address - Phone:775-434-8183
Mailing Address - Fax:440-580-7025
Practice Address - Street 1:111 W TELEGRAPH ST
Practice Address - Street 2:STE 204
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-4266
Practice Address - Country:US
Practice Address - Phone:775-434-8183
Practice Address - Fax:440-580-7025
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-07
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner