Provider Demographics
NPI:1316351901
Name:GELLER, JEFFREY ROBERT (DPT)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ROBERT
Last Name:GELLER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3131 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-0951
Mailing Address - Country:US
Mailing Address - Phone:928-718-0718
Mailing Address - Fax:
Practice Address - Street 1:3131 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-0951
Practice Address - Country:US
Practice Address - Phone:928-718-0718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10539225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist