Provider Demographics
NPI:1407823883
Name:GEISENHEIMER, ROBERTA DIANE (PT)
Entity Type:Individual
Prefix:MRS
First Name:ROBERTA
Middle Name:DIANE
Last Name:GEISENHEIMER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 HORIZON RD
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-6525
Mailing Address - Country:US
Mailing Address - Phone:201-224-4968
Mailing Address - Fax:201-224-7754
Practice Address - Street 1:2 HORIZON RD
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-6525
Practice Address - Country:US
Practice Address - Phone:201-224-4968
Practice Address - Fax:201-224-7754
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002200225100000X
NJQA02416225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist