Healthcare Provider Details

I. General information

NPI: 1093247280
Provider Name (Legal Business Name): TRENT GELEYNSE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 03/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 9TH ST SE
SIOUX CENTER IA
51250-2501
US

IV. Provider business mailing address

1101 9TH ST SE
SIOUX CENTER IA
51250-2501
US

V. Phone/Fax

Practice location:
  • Phone: 712-722-8125
  • Fax: 712-722-8315
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number074992
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: