Provider Demographics
NPI:1265240279
Name:GERASIMENKO, SHIELA (PT DPT)
Entity type:Individual
Prefix:MRS
First Name:SHIELA
Middle Name:
Last Name:GERASIMENKO
Suffix:
Gender:F
Credentials:PT DPT
Other - Prefix:
Other - First Name:SHIELA
Other - Middle Name:URETA
Other - Last Name:MIRAFLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT DPT
Mailing Address - Street 1:220 A ST
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-8345
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22461 I 30 STE 1000
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-2378
Practice Address - Country:US
Practice Address - Phone:501-776-1814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-23
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR5108225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist