Provider Demographics
NPI:1477845675
Name:OHMANN, GINA J (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MS
First Name:GINA
Middle Name:J
Last Name:OHMANN
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:G
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4705 INDIAN TRAIL FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-8515
Mailing Address - Country:US
Mailing Address - Phone:704-882-3105
Mailing Address - Fax:704-882-3762
Practice Address - Street 1:4705 INDIAN TRAIL FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-8515
Practice Address - Country:US
Practice Address - Phone:704-882-3105
Practice Address - Fax:704-882-3762
Is Sole Proprietor?:No
Enumeration Date:2011-05-05
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11328225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2503590AMedicare PIN
NC2506459Medicare PIN