Provider Demographics
NPI:1225317720
Name:GEEDEY, DIANA DENISE (PTA, C PED)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:DENISE
Last Name:GEEDEY
Suffix:
Gender:F
Credentials:PTA, C PED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:TURBOTVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17772-8548
Mailing Address - Country:US
Mailing Address - Phone:570-898-9192
Mailing Address - Fax:570-649-6910
Practice Address - Street 1:17 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:TURBOTVILLE
Practice Address - State:PA
Practice Address - Zip Code:17772-8548
Practice Address - Country:US
Practice Address - Phone:570-898-9192
Practice Address - Fax:570-649-6910
Is Sole Proprietor?:No
Enumeration Date:2011-08-15
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1127224L00000X
PATEI001974225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist