Healthcare Provider Details

I. General information

NPI: 1033219159
Provider Name (Legal Business Name): GEOFFREY DAVID DIEK PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 W EMELITA AVE STE 449
MESA AZ
85202-4034
US

IV. Provider business mailing address

4145 NORTH GLOUCESTER PLACE
ATLANTA GA
30341-1249
US

V. Phone/Fax

Practice location:
  • Phone: 480-933-5065
  • Fax:
Mailing address:
  • Phone: 404-992-6229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberPT005701
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: