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General NPI Number Information
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NPI Number | 1235550781
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Entity Type | Individual
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Provider Name | GREG GEISELMAN PTA
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Gender | Male
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Dates
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Enumeration Date | 01/01/2014
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Last Update Date | 03/03/2015
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Provider Practice Location Address
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Address Line | 800 COMPASSION WAY
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City | DODGEVILLE
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State | WI
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Zip | 53533-1956
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Country | US
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Telephone | 608-930-7210
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Fax |
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Provider Business Mailing Address
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Address Line | 20932 BUCK RUN LN
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City | RICHLAND CENTER
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State | WI
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Zip | 53581-8677
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Country | US
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Telephone | 608-475-3620
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2055-19
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License Number State | WI
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