Provider Demographics
NPI:1013227909
Name:SALISBURY, GINA BROCKHUIZEN (RPT)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:BROCKHUIZEN
Last Name:SALISBURY
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 MELBOURNE GRN
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-8612
Mailing Address - Country:US
Mailing Address - Phone:585-377-7931
Mailing Address - Fax:
Practice Address - Street 1:600 PARDEE ROAD
Practice Address - Street 2:EAST IRONDEQUOIT CENTRAL SCHOOL DISTRICT
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14609
Practice Address - Country:US
Practice Address - Phone:585-339-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013145225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist