Provider Demographics
NPI:1457844920
Name:GERAGHTY, MARIE
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:GERAGHTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 YONKERS AVE
Mailing Address - Street 2:STE 109
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-3063
Mailing Address - Country:US
Mailing Address - Phone:914-776-7310
Mailing Address - Fax:914-776-7566
Practice Address - Street 1:1053 W BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-3329
Practice Address - Country:US
Practice Address - Phone:914-381-0203
Practice Address - Fax:914-381-0207
Is Sole Proprietor?:No
Enumeration Date:2018-06-10
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042759225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist