Provider Demographics
NPI:1083638316
Name:MEYER, GINA D (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:D
Last Name:MEYER
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8561
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23450-8561
Mailing Address - Country:US
Mailing Address - Phone:757-748-6003
Mailing Address - Fax:
Practice Address - Street 1:1408 N GREAT NECK RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-1315
Practice Address - Country:US
Practice Address - Phone:757-694-7872
Practice Address - Fax:757-340-6210
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1154270225100000X
IL070015810225100000X
VA2305207230225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCD3789OtherMEDICARE RAILRODA GROUP NUMBER
IL1619908OtherBCBS IL GROUP
ILP00602549OtherMEDICARE RAILROAD NUMBER
IL568080Medicare PIN
IL567700Medicare PIN
ILR00386Medicare PIN
IL568150Medicare PIN
IL1619908OtherBCBS IL GROUP
ILR00385Medicare PIN
ILP00602549OtherMEDICARE RAILROAD NUMBER