Provider Demographics
NPI:1609026962
Name:GERONIMO, GEORGE GARCIA (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:GARCIA
Last Name:GERONIMO
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3624 AUSTIN PEAY HWY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38128-3776
Mailing Address - Country:US
Mailing Address - Phone:901-372-7324
Mailing Address - Fax:
Practice Address - Street 1:3624 AUSTIN PEAY HWY
Practice Address - Street 2:SUITE 1
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-3776
Practice Address - Country:US
Practice Address - Phone:901-372-7324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0000002478225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist