Provider Demographics
NPI:1053650259
Name:ENDERS, GEOFFREY LEE (DPT)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:LEE
Last Name:ENDERS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 MEDDLETON DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755-7189
Mailing Address - Country:US
Mailing Address - Phone:573-579-9512
Mailing Address - Fax:
Practice Address - Street 1:2387 W JACKSON BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:JACKSON
Practice Address - State:MO
Practice Address - Zip Code:63755-3024
Practice Address - Country:US
Practice Address - Phone:573-243-0210
Practice Address - Fax:573-243-5697
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013004039225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist