Provider Demographics
NPI:1689986283
Name:VAN DER GEEST, CAITLYN MARIE (DPT)
Entity Type:Individual
Prefix:MS
First Name:CAITLYN
Middle Name:MARIE
Last Name:VAN DER GEEST
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 W RIVER ROAD
Mailing Address - Street 2:
Mailing Address - City:MOSINEE
Mailing Address - State:WI
Mailing Address - Zip Code:54455
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1767 PARK AVE
Practice Address - Street 2:
Practice Address - City:PLOVER
Practice Address - State:WI
Practice Address - Zip Code:54467-4301
Practice Address - Country:US
Practice Address - Phone:715-544-1570
Practice Address - Fax:715-544-1566
Is Sole Proprietor?:No
Enumeration Date:2010-07-12
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23343225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist