Provider Demographics
NPI:1598807018
Name:GERAGHTY, LAUREL J (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:LAUREL
Middle Name:J
Last Name:GERAGHTY
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 CISNEY AVE
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-3247
Mailing Address - Country:US
Mailing Address - Phone:516-354-6147
Mailing Address - Fax:
Practice Address - Street 1:22 CISNEY AVE
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-3247
Practice Address - Country:US
Practice Address - Phone:516-354-6147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0190662251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics