Provider Demographics
NPI:1952519712
Name:GEISER, MARY BETH (PT)
Entity Type:Individual
Prefix:
First Name:MARY BETH
Middle Name:
Last Name:GEISER
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 1:2305 WILLOW VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:BELGIUM
Mailing Address - State:WI
Mailing Address - Zip Code:53004-9448
Mailing Address - Country:US
Mailing Address - Phone:262-285-7600
Mailing Address - Fax:
Practice Address - Street 1:1249 W LIEBAU RD
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-3396
Practice Address - Country:US
Practice Address - Phone:262-243-4161
Practice Address - Fax:262-243-4166
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3932225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic