Provider Demographics
NPI:1174674550
Name:ROSS, GINA MARIE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:MARIE
Last Name:ROSS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27381 VIA PRIMERO
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-1912
Mailing Address - Country:US
Mailing Address - Phone:949-837-2055
Mailing Address - Fax:949-837-2055
Practice Address - Street 1:23521 PASEO DE VALENCIA
Practice Address - Street 2:SUITE B15
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3107
Practice Address - Country:US
Practice Address - Phone:949-597-0007
Practice Address - Fax:949-597-0040
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3038225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant