Provider Demographics
NPI:1467659615
Name:MAHINAY, GEMMA LORNA DAQUIPA (PT)
Entity Type:Individual
Prefix:MRS
First Name:GEMMA LORNA
Middle Name:DAQUIPA
Last Name:MAHINAY
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 1:3325 YALE DR
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47711-7305
Mailing Address - Country:US
Mailing Address - Phone:502-552-1422
Mailing Address - Fax:
Practice Address - Street 1:1282 MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IN
Practice Address - Zip Code:47620-1365
Practice Address - Country:US
Practice Address - Phone:812-307-1089
Practice Address - Fax:812-307-1177
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05007883A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN155238Medicaid