Basic Information
| Provider Information | |||||||||
| NPI: | 1689773087 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GEDDENS | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | DUNCAN | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4500 STUART ST | ||||||||
| Address2: | MACH ATTN: MCXL-PQ (CREDENTIALS) | ||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292075700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037512618 | ||||||||
| FaxNumber: | 8037512689 | ||||||||
| Practice Location | |||||||||
| Address1: | 4500 STUART ST | ||||||||
| Address2: | MACH ATTN: MCXL-PQ (CREDENTIALS) | ||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037512618 | ||||||||
| FaxNumber: | 8037512689 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2006 | ||||||||
| LastUpdateDate: | 06/25/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 5168 | SC | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 171000000X | 5168 | SC | Y | Other Service Providers | Military Health Care Provider |
ID Information
| ID | Type | State | Issuer | Description | 1689773087 | 01 | SC | FEDERAL GOVERNMENT | OTHER |