Provider Demographics
NPI:1053376913
Name:VALENTINE, GEROLD WAYNE JR (PT)
Entity type:Individual
Prefix:MR
First Name:GEROLD
Middle Name:WAYNE
Last Name:VALENTINE
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:JERRY
Other - Middle Name:
Other - Last Name:VALENTINE
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1424 AIRPORT FWY STE U
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-6783
Mailing Address - Country:US
Mailing Address - Phone:817-858-0390
Mailing Address - Fax:817-858-0842
Practice Address - Street 1:1424 AIRPORT FWY
Practice Address - Street 2:# U
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6787
Practice Address - Country:US
Practice Address - Phone:817-858-0390
Practice Address - Fax:817-858-0842
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1102549225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist