Provider Demographics
NPI:1386847051
Name:TRIPP, GINGER (PT)
Entity Type:Individual
Prefix:
First Name:GINGER
Middle Name:
Last Name:TRIPP
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 1:66 SEVEN WONDERS TRL
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-5419
Mailing Address - Country:US
Mailing Address - Phone:386-503-6070
Mailing Address - Fax:
Practice Address - Street 1:4721 E MOODY BLVD
Practice Address - Street 2:BLG 1 STE 103
Practice Address - City:BUNNELL
Practice Address - State:FL
Practice Address - Zip Code:32110-7705
Practice Address - Country:US
Practice Address - Phone:386-586-1229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT19628225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT19628OtherSTATE LICENSE