Provider Demographics
NPI:1902328347
Name:GEDDIS, J MITCHELL (ATC)
Entity Type:Individual
Prefix:
First Name:J
Middle Name:MITCHELL
Last Name:GEDDIS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8858 CLAY ST
Mailing Address - Street 2:
Mailing Address - City:MONTVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44064
Mailing Address - Country:US
Mailing Address - Phone:440-279-3630
Mailing Address - Fax:
Practice Address - Street 1:310 E MARKET ST
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883
Practice Address - Country:US
Practice Address - Phone:440-279-3630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-07
Last Update Date:2017-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
22OtherRESPIRATORY, REHABILITATIVE, AND RESTORATIVE SERVICE PROVIDERS