MEDICARE: MA. YVONNE SIEVERT GERONIMO P.T.

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	PT0000002334	TN

General Provider Information

NPI Number	:	1750522009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MA. YVONNE SIEVERT GERONIMO P.T.

Provider Business Mailing Address
First Line	:	5300 COTTONWOOD RD STE 1
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38118-2620
Country	:	US
Telephone Number	:	901-363-2500
Fax Number	:	901-363-4777

Provider Business Practice Location Address
First Line	:	5300 COTTONWOOD RD STE 1
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38118-2620
Country	:	US
Telephone Number	:	901-363-2500
Fax Number	:	901-363-4777

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

Provider Enumeration Date	:	03/17/2009
Last Update Date	:	03/17/2009

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