Provider Demographics
NPI:1093545550
Name:GEROUX, DESIREE MAIRE (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:MAIRE
Last Name:GEROUX
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:PA
Mailing Address - Zip Code:17361-1911
Mailing Address - Country:US
Mailing Address - Phone:410-458-4257
Mailing Address - Fax:
Practice Address - Street 1:2300 E MARKET ST STE 206
Practice Address - Street 2:
Practice Address - City:EAST YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-2858
Practice Address - Country:US
Practice Address - Phone:410-458-4257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG013189225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist