MEDICARE: MR. ANTHONY W GESELL PT

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	8288	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0777Y	OTHER	NC	BCBS GROUP NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326085150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANTHONY W GESELL PT

Provider Business Mailing Address
First Line	:	1703 WALLACE DR W
Second Line	:
City	:	WILSON
State	:	NC
Zip	:	27893-2797
Country	:	US
Telephone Number	:	252-243-6386
Fax Number	:

Provider Business Practice Location Address
First Line	:	1811 FOREST HILLS RD W
Second Line	:
City	:	WILSON
State	:	NC
Zip	:	27893-3412
Country	:	US
Telephone Number	:	252-243-7400
Fax Number	:	252-243-3291

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

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	07/09/2007

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