Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 6229 | MA |
N | 2251S0007X | Physical Therapist - Sports | 6229 | MA |
N | 2251X0800X | Physical Therapist - Orthopedic | 6229 | MA |
NPI | 1316929151 |
---|---|
Provider Name | Mr. Gary Joseph Geissler |
First Address | Lexington, MA 02420-2807 |
Second Address | Wellesley, MA 02481-6219 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2005 |
Last Update Date | 08/07/2007 |