Provider Demographics
NPI:1528781853
Name:GEIER, IAN BRUCE (PTA)
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:BRUCE
Last Name:GEIER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21140 E TWIN ACRES DR
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-6542
Mailing Address - Country:US
Mailing Address - Phone:602-737-2275
Mailing Address - Fax:
Practice Address - Street 1:21576 S ELLSWORTH LOOP RD # 108
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-7685
Practice Address - Country:US
Practice Address - Phone:602-737-2275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPTA-014558225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant