Provider Demographics
NPI:1033881990
Name:GEERDES, MARK RYAN (PT, DPT)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:RYAN
Last Name:GEERDES
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3161 43RD ST S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-8791
Mailing Address - Country:US
Mailing Address - Phone:701-893-2639
Mailing Address - Fax:701-893-2638
Practice Address - Street 1:3161 43RD ST S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-8791
Practice Address - Country:US
Practice Address - Phone:701-893-2639
Practice Address - Fax:701-893-2638
Is Sole Proprietor?:No
Enumeration Date:2021-09-29
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2727225100000X
MN12345225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist