Provider Demographics
NPI:1225638893
Name:BJELAC, GINA (PT)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:BJELAC
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 1:555 MEADOWAY PARK
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-3735
Mailing Address - Country:US
Mailing Address - Phone:614-563-3236
Mailing Address - Fax:
Practice Address - Street 1:597 EXECUTIVE CAMPUS DR
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-8870
Practice Address - Country:US
Practice Address - Phone:614-563-3236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-31
Last Update Date:2020-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH013960225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist