Healthcare Provider Details

I. General information

NPI: 1316351901
Provider Name (Legal Business Name): JEFFREY ROBERT GELLER D.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2014
Last Update Date: 06/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 WESTERN AVE
KINGMAN AZ
86401-0951
US

IV. Provider business mailing address

3131 WESTERN AVE
KINGMAN AZ
86401-0951
US

V. Phone/Fax

Practice location:
  • Phone: 928-718-0718
  • Fax:
Mailing address:
  • Phone: 928-718-0718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number10539
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: