MEDICARE: MRS. STACY M GEESAMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT010189L	PA

General Provider Information

NPI Number	:	1275085458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STACY M GEESAMAN

Provider Business Mailing Address
First Line	:	6 FOXRUN TER
Second Line	:
City	:	LITITZ
State	:	PA
Zip	:	17543-7905
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 SAINT LUKE DR
Second Line	:
City	:	LITITZ
State	:	PA
Zip	:	17543-2208
Country	:	US
Telephone Number	:	717-626-6884
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2016
Last Update Date	:	11/03/2016

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