MEDICARE: MRS. GE'ONNA MARIE DECKER MS,PT

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	05004846A	IN

General Provider Information

NPI Number	:	1881712024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GE'ONNA MARIE DECKER MS,PT

Provider Business Mailing Address
First Line	:	1159 E KENNYS CT N
Second Line	:
City	:	COLUMBIA CITY
State	:	IN
Zip	:	46725-8950
Country	:	US
Telephone Number	:	260-610-3008
Fax Number	:	260-691-2795

Provider Business Practice Location Address
First Line	:	1159 E KENNYS CT N
Second Line	:
City	:	COLUMBIA CITY
State	:	IN
Zip	:	46725-8950
Country	:	US
Telephone Number	:	260-610-3008
Fax Number	:	260-691-2795

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

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	07/08/2007

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