Healthcare Provider Details

I. General information

NPI: 1255481826
Provider Name (Legal Business Name): ERNEST DALE GEIGER PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 ROBERT BUSH DRIVE
SOUTH BEND WA
98586
US

IV. Provider business mailing address

1010 ROBERT BUSH DRIVE
SOUTH BEND WA
98586
US

V. Phone/Fax

Practice location:
  • Phone: 360-875-5543
  • Fax: 360-875-5544
Mailing address:
  • Phone: 360-875-5543
  • Fax: 360-875-5544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT00003050
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: