MEDICARE: MRS. LAUREL J GERAGHTY MSPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251P0200X	Pediatric Physical Therapist	019066	NY

General Provider Information

NPI Number	:	1598807018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAUREL J GERAGHTY MSPT

Provider Business Mailing Address
First Line	:	22 CISNEY AVE
Second Line	:
City	:	FLORAL PARK
State	:	NY
Zip	:	11001-3247
Country	:	US
Telephone Number	:	516-354-6147
Fax Number	:

Provider Business Practice Location Address
First Line	:	22 CISNEY AVE
Second Line	:
City	:	FLORAL PARK
State	:	NY
Zip	:	11001-3247
Country	:	US
Telephone Number	:	516-354-6147
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	07/08/2007

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