Provider Demographics
NPI:1962392050
Name:GEMEREK, EVAN MICHAEL (PT, DPT)
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:MICHAEL
Last Name:GEMEREK
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 HIDDEN TRL
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NY
Mailing Address - Zip Code:14086-9684
Mailing Address - Country:US
Mailing Address - Phone:716-468-5236
Mailing Address - Fax:
Practice Address - Street 1:1429 S PIONEER WAY
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-2458
Practice Address - Country:US
Practice Address - Phone:509-765-9608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-08
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT70013469208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation