Provider Demographics
NPI:1164443693
Name:GERACI, RICHARD B (MS PT)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:B
Last Name:GERACI
Suffix:
Gender:M
Credentials:MS PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412 ALGUNO RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-3302
Mailing Address - Country:US
Mailing Address - Phone:512-619-3407
Mailing Address - Fax:512-407-8424
Practice Address - Street 1:5555 N LAMAR BLVD
Practice Address - Street 2:SUITE C-121
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751-1073
Practice Address - Country:US
Practice Address - Phone:512-407-8651
Practice Address - Fax:512-407-8424
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1148960225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist