MEDICARE: GEOFFREY LEE ENDERS DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2013004039	MO

General Provider Information

NPI Number	:	1053650259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEOFFREY LEE ENDERS DPT

Provider Business Mailing Address
First Line	:	266 MEDDLETON DR
Second Line	:
City	:	JACKSON
State	:	MO
Zip	:	63755-7189
Country	:	US
Telephone Number	:	573-579-9512
Fax Number	:

Provider Business Practice Location Address
First Line	:	2387 W JACKSON BLVD
Second Line	:	SUITE C
City	:	JACKSON
State	:	MO
Zip	:	63755-3024
Country	:	US
Telephone Number	:	573-243-0210
Fax Number	:	573-243-5697

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2013
Last Update Date	:	02/07/2013

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Directions to “ GEOFFREY LEE ENDERS DPT” Practice Location

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