Provider Demographics
NPI:1972786127
Name:GEDDIS INSKEEP, MARY J (LMT)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:J
Last Name:GEDDIS INSKEEP
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:J
Other - Last Name:INSKEEP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:PO BOX 443
Mailing Address - Street 2:
Mailing Address - City:CEDAR KEY
Mailing Address - State:FL
Mailing Address - Zip Code:32625
Mailing Address - Country:US
Mailing Address - Phone:352-543-6107
Mailing Address - Fax:
Practice Address - Street 1:6510 SW 109 CT
Practice Address - Street 2:
Practice Address - City:CEDAR KEY
Practice Address - State:FL
Practice Address - Zip Code:32625
Practice Address - Country:US
Practice Address - Phone:352-543-6107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-11
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA005651225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA005651OtherWORKERS COMP
FLC1522OtherBLUE CROSS BLUE SHIELD