MEDICARE: MR. THOMAS JAMES GEISSLER PTA

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	225200000X	Physical Therapy Assistant	PENDING	MN

General Provider Information

NPI Number	:	1659542876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS JAMES GEISSLER PTA

Provider Business Mailing Address
First Line	:	4415 W 36 1/2 ST
Second Line	:
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416-4854
Country	:	US
Telephone Number	:	952-927-9717
Fax Number	:

Provider Business Practice Location Address
First Line	:	4415 W 36 1/2 ST
Second Line	:
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416-4854
Country	:	US
Telephone Number	:	952-927-9717
Fax Number	:

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

Provider Enumeration Date	:	03/14/2008
Last Update Date	:	03/14/2008

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