Healthcare Provider Details

I. General information

NPI: 1902328347
Provider Name (Legal Business Name): J MITCHELL GEDDIS ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2017
Last Update Date: 07/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 E MARKET ST
TIFFIN OH
44883
US

IV. Provider business mailing address

8858 CLAY ST
MONTVILLE OH
44064
US

V. Phone/Fax

Practice location:
  • Phone: 440-279-3630
  • Fax:
Mailing address:
  • Phone: 440-279-3630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: