Healthcare Provider Details

I. General information

NPI: 1053010439
Provider Name (Legal Business Name): ANDREW JON GEDDRY CTRS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2023
Last Update Date: 02/24/2023
Certification Date: 02/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SPRINGS RD
BEDFORD MA
01730-1114
US

IV. Provider business mailing address

200 SPRINGS RD
BEDFORD MA
01730-1114
US

V. Phone/Fax

Practice location:
  • Phone: 781-687-3237
  • Fax:
Mailing address:
  • Phone: 781-687-3237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: