Provider Demographics
NPI:1912263567
Name:GEESEY-JEAN, SUE LOLA (ATC,L)
Entity Type:Individual
Prefix:MRS
First Name:SUE
Middle Name:LOLA
Last Name:GEESEY-JEAN
Suffix:
Gender:F
Credentials:ATC,L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 BUSINESS ROUTE 4
Mailing Address - Street 2:SUITE #1
Mailing Address - City:CENTER RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05736-9701
Mailing Address - Country:US
Mailing Address - Phone:802-775-4372
Mailing Address - Fax:
Practice Address - Street 1:279 BUSINESS ROUTE 4
Practice Address - Street 2:SUITE #1
Practice Address - City:CENTER RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05736-9701
Practice Address - Country:US
Practice Address - Phone:802-775-4372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT104.0000175172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist