Provider Demographics
NPI:1033219159
Name:DIEK, GEOFFREY DAVID (PT)
Entity type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:DAVID
Last Name:DIEK
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 1:4145 NORTH GLOUCESTER PLACE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1249
Mailing Address - Country:US
Mailing Address - Phone:404-992-6229
Mailing Address - Fax:
Practice Address - Street 1:1825 W EMELITA AVE STE 449
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4034
Practice Address - Country:US
Practice Address - Phone:480-933-5065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT005701173000000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPT005701OtherSTATE LIC