Provider Demographics
NPI:1952305856
Name:CLEALL, GEOFFREY DEAN (CP)
Entity Type:Individual
Prefix:MR
First Name:GEOFFREY
Middle Name:DEAN
Last Name:CLEALL
Suffix:
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 BEE RIDGE RD
Mailing Address - Street 2:STE 4
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-1157
Mailing Address - Country:US
Mailing Address - Phone:941-925-2720
Mailing Address - Fax:
Practice Address - Street 1:3801 BEE RIDGE RD
Practice Address - Street 2:STE 4
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-1157
Practice Address - Country:US
Practice Address - Phone:941-925-2720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-08
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCP2482224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1094970001Medicare NSC