MEDICARE: MS. CAITLYN MARIE VAN DER GEEST 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	23343	MD

General Provider Information

NPI Number	:	1689986283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAITLYN MARIE VAN DER GEEST DPT

Provider Business Mailing Address
First Line	:	902 W RIVER ROAD
Second Line	:
City	:	MOSINEE
State	:	WI
Zip	:	54455
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1767 PARK AVE
Second Line	:
City	:	PLOVER
State	:	WI
Zip	:	54467-4301
Country	:	US
Telephone Number	:	715-544-1570
Fax Number	:	715-544-1566

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

Provider Enumeration Date	:	07/12/2010
Last Update Date	:	01/25/2017

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