Healthcare Provider Details

I. General information

NPI: 1861579807
Provider Name (Legal Business Name): JOSEPH ALFORD GEDDES PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/04/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 OAK AVENUE PKWY STE B
FOLSOM CA
95630-6871
US

IV. Provider business mailing address

PO BOX 2710
GRANITE BAY CA
95746-2710
US

V. Phone/Fax

Practice location:
  • Phone: 916-932-1210
  • Fax: 916-932-1205
Mailing address:
  • Phone: 916-932-1210
  • Fax: 916-932-1205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 30235
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: