Provider Demographics
NPI:1306013503
Name:DEVINE, GINGER TAPP (PT)
Entity Type:Individual
Prefix:
First Name:GINGER
Middle Name:TAPP
Last Name:DEVINE
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 1:140 DENBERRY LN
Mailing Address - Street 2:
Mailing Address - City:WEST PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42086-9541
Mailing Address - Country:US
Mailing Address - Phone:270-744-8004
Mailing Address - Fax:
Practice Address - Street 1:140 DENBERRY LN
Practice Address - Street 2:
Practice Address - City:WEST PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42086-9541
Practice Address - Country:US
Practice Address - Phone:270-744-8004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY003132225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist