MEDICARE: MR. THOMAS MICHAEL GEISEN 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	17733	CA

General Provider Information

NPI Number	:	1720095722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS MICHAEL GEISEN PT

Provider Business Mailing Address
First Line	:	27184 SENA CT
Second Line	:
City	:	VALENCIA
State	:	CA
Zip	:	91354-2233
Country	:	US
Telephone Number	:	661-297-7726
Fax Number	:	661-297-7726

Provider Business Practice Location Address
First Line	:	27184 SENA CT
Second Line	:
City	:	VALENCIA
State	:	CA
Zip	:	91354-2233
Country	:	US
Telephone Number	:	661-297-7726
Fax Number	:	661-297-7726

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

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	07/08/2007

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