MEDICARE: DR. J WYNNE GEIKENJOYNER PT, DPT, MS

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	6878	AZ

General Provider Information

NPI Number	:	1568871366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. J WYNNE GEIKENJOYNER PT, DPT, MS

Provider Business Mailing Address
First Line	:	4247 CANYON LOOP
Second Line	:
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86005-3726
Country	:	US
Telephone Number	:	928-853-0352
Fax Number	:

Provider Business Practice Location Address
First Line	:	4247 CANYON LOOP
Second Line	:
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86005-3726
Country	:	US
Telephone Number	:	928-853-0352
Fax Number	:

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

Provider Enumeration Date	:	08/05/2014
Last Update Date	:	08/05/2014

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