Individual
STACEY GERSBACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
600 NW 11TH ST STE E31, HERMISTON, OR 97838-8604
(541) 667-3657
Mailing address
80011 AGNEW RD, HERMISTON, OR 97838-7138
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
9538
OR
Other
Enumeration date
09/04/2018
Last updated
09/04/2018
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