Provider Demographics
NPI:1255481826
Name:GEIGER, ERNEST DALE (PT)
Entity Type:Individual
Prefix:MR
First Name:ERNEST
Middle Name:DALE
Last Name:GEIGER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 ROBERT BUSH DRIVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:WA
Mailing Address - Zip Code:98586
Mailing Address - Country:US
Mailing Address - Phone:360-875-5543
Mailing Address - Fax:360-875-5544
Practice Address - Street 1:1010 ROBERT BUSH DRIVE
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:WA
Practice Address - Zip Code:98586
Practice Address - Country:US
Practice Address - Phone:360-875-5543
Practice Address - Fax:360-875-5544
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00003050225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7007545Medicaid
WA7007545Medicaid