Healthcare Provider Details

I. General information

NPI: 1336549427
Provider Name (Legal Business Name): PATRICIA GEFFRE-STARR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2014
Last Update Date: 08/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3322 W WILLOW KNOLLS DR
PEORIA IL
61614-8148
US

IV. Provider business mailing address

6516 S ADAMS ST
BARTONVILLE IL
61607-2559
US

V. Phone/Fax

Practice location:
  • Phone: 309-690-3322
  • Fax: 309-690-3323
Mailing address:
  • Phone: 309-338-3581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number227009527
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: