Provider Demographics
NPI:1932248127
Name:STATON, GEOFFREY SCOTT (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:SCOTT
Last Name:STATON
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9025 N EDISON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-2908
Mailing Address - Country:US
Mailing Address - Phone:503-750-2167
Mailing Address - Fax:503-283-0785
Practice Address - Street 1:12119 SE STEVENS CT
Practice Address - Street 2:
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-2620
Practice Address - Country:US
Practice Address - Phone:503-353-1278
Practice Address - Fax:503-353-1273
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3819225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist