Provider Demographics
NPI:1932403953
Name:WILLARD, GEOFFREY DANIEL (PT, DPT, NCS)
Entity Type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:DANIEL
Last Name:WILLARD
Suffix:
Gender:M
Credentials:PT, DPT, NCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11701 SAN JOSE BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-0756
Mailing Address - Country:US
Mailing Address - Phone:904-345-7450
Mailing Address - Fax:904-345-7451
Practice Address - Street 1:11701 SAN JOSE BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-0756
Practice Address - Country:US
Practice Address - Phone:904-345-7450
Practice Address - Fax:904-345-7451
Is Sole Proprietor?:No
Enumeration Date:2011-01-05
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT26107225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist