Provider Demographics
NPI:1669692919
Name:GIUFFRIDA, GERALYN M (PT)
Entity type:Individual
Prefix:MRS
First Name:GERALYN
Middle Name:M
Last Name:GIUFFRIDA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:GERALYN
Other - Middle Name:M
Other - Last Name:BAYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2165 HIGHWAY V
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-6004
Mailing Address - Country:US
Mailing Address - Phone:636-250-5202
Mailing Address - Fax:660-250-5203
Practice Address - Street 1:REORGANIZED SCHOOL DIST 5
Practice Address - Street 2:2165 HIGHWAY V
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-6004
Practice Address - Country:US
Practice Address - Phone:636-250-5202
Practice Address - Fax:660-250-5203
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01233225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO487485104Medicaid