Provider Demographics
NPI:1649689563
Name:GERAGHTY, PATRICK (DPT)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:GERAGHTY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3115 NE SANDY BLVD
Mailing Address - Street 2:SUITE 231
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2776
Mailing Address - Country:US
Mailing Address - Phone:406-370-8974
Mailing Address - Fax:
Practice Address - Street 1:3115 NE SANDY BLVD
Practice Address - Street 2:SUITE 231
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2776
Practice Address - Country:US
Practice Address - Phone:406-370-8974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-05
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR60228225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist