Provider Demographics
NPI:1356870562
Name:GEER, CRYSTAL (PT)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:GEER
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 1:236 W WALTANN LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-3666
Mailing Address - Country:US
Mailing Address - Phone:602-430-1406
Mailing Address - Fax:
Practice Address - Street 1:4440 N 36TH ST STE 240
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-3592
Practice Address - Country:US
Practice Address - Phone:602-956-4040
Practice Address - Fax:602-956-4011
Is Sole Proprietor?:No
Enumeration Date:2017-06-09
Last Update Date:2017-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13042225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist