Healthcare Provider Details

I. General information

NPI: 1689773087
Provider Name (Legal Business Name): ROBERT DUNCAN GEDDENS D.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 8TH DIVISION RD
COLUMBIA SC
29207-5700
US

IV. Provider business mailing address

4500 8TH DIVISION RD
COLUMBIA SC
29207-5700
US

V. Phone/Fax

Practice location:
  • Phone: 803-751-0321
  • Fax: 803-751-0321
Mailing address:
  • Phone: 803-751-2618
  • Fax: 803-751-2689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5168
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: