Individual ProviderLydel Marie GerondalePhysical Therapy AssistantRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPractice Address2305 San Luis Pl, Green Bay, WI 54304-5211(920) 494-5231(920) 604-0631PECOS EnrollmentBased on the most recent information from CMS, provider Lydel Marie Gerondale does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1538668405Provider TypeIndividualFull NameGerondale, Lydel MarieCredentialPTAGenderFemaleSole ProprietorNoEnumeration Date2/6/2018Last Updated2/6/2018Contact InformationPractice LocationPractice Address2305 San Luis Pl, Green Bay, WI 54304-5211Phone(920) 494-5231FaxUnlisted FaxMailing LocationMailing Address1112 Roland Ln Apt 16, Green Bay, WI 54303-6394Phone(920) 604-0631FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode225200000XPrimaryDescriptionPhysical Therapy AssistantRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicense2504-19Wisconsin