Provider Demographics
NPI:1295041549
Name:LANIER, GINA F (LPTA)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:F
Last Name:LANIER
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 E MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:AHOSKIE
Mailing Address - State:NC
Mailing Address - Zip Code:27910-3919
Mailing Address - Country:US
Mailing Address - Phone:252-332-6760
Mailing Address - Fax:252-332-1688
Practice Address - Street 1:1109 E MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:AHOSKIE
Practice Address - State:NC
Practice Address - Zip Code:27910-3919
Practice Address - Country:US
Practice Address - Phone:252-332-6760
Practice Address - Fax:252-332-1688
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3487225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant