Provider Demographics
NPI:1083033732
Name:MAMARIL, GEMMALYN (PT)
Entity Type:Individual
Prefix:
First Name:GEMMALYN
Middle Name:
Last Name:MAMARIL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9411 ELM CT
Mailing Address - Street 2:APT. 633
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20111-8299
Mailing Address - Country:US
Mailing Address - Phone:540-395-9328
Mailing Address - Fax:
Practice Address - Street 1:9411 ELM CT
Practice Address - Street 2:APT. 633
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20111-8299
Practice Address - Country:US
Practice Address - Phone:540-395-9328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-09
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305207588225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist