Provider Demographics
NPI:1447630975
Name:LEONA GERAGHTY
Entity type:Organization
Organization Name:LEONA GERAGHTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:LEONA
Authorized Official - Middle Name:
Authorized Official - Last Name:GERAGHTY
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:760-579-2868
Mailing Address - Street 1:4352 ARBOR COVE CIR
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92058-6954
Mailing Address - Country:US
Mailing Address - Phone:760-579-2868
Mailing Address - Fax:
Practice Address - Street 1:4352 ARBOR COVE CIR
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92058-6954
Practice Address - Country:US
Practice Address - Phone:760-579-2868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-29
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT2949251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health