Provider Demographics
NPI:1326211921
Name:CABALLERO, GINA
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:CABALLERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22731 NEWMAN ST
Mailing Address - Street 2:SUITE 100 B
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2034
Mailing Address - Country:US
Mailing Address - Phone:313-791-0616
Mailing Address - Fax:313-791-0632
Practice Address - Street 1:22731 NEWMAN ST
Practice Address - Street 2:SUITE 100 B
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2034
Practice Address - Country:US
Practice Address - Phone:313-791-0616
Practice Address - Fax:313-791-0632
Is Sole Proprietor?:No
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012237225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist