Provider Demographics
NPI:1427180058
Name:GERACHENKO, NATALIA (MPT)
Entity Type:Individual
Prefix:
First Name:NATALIA
Middle Name:
Last Name:GERACHENKO
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17B FIRSTFIELD RD STE 105
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-1785
Mailing Address - Country:US
Mailing Address - Phone:301-990-1449
Mailing Address - Fax:301-990-1016
Practice Address - Street 1:17B FIRSTFIELD RD STE 105
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-1785
Practice Address - Country:US
Practice Address - Phone:301-990-1449
Practice Address - Fax:301-990-1016
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18893225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD480182OtherMDIPA
MD480182OtherALLIANCE
MD01-0795823OtherCIGNA
MD110AOtherCAREFIRST
MD010795823OtherUNICARE
MD126052700OtherUS DEPARTMENT OF LABOR
MD480182OtherMAMSI
DCJ1080001OtherCAREFIRST
MD01-0795823OtherGREATWEST
MD010795823OtherPHCS
MD010795823OtherUNITED HEALTHCARE
MD405806200Medicaid
MD01-0795823OtherGUARDIAN
MD3312816OtherAETNA HMO, POS
MD7097210OtherAETNA PPO
MD010795823OtherNCPPO PLAN 499247
MD480182OtherOPTIMUM CHOICE