Provider Demographics
NPI:1497801799
Name:MUSOLINO, GINA MARIA (PT, MSED, EDD)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:MARIA
Last Name:MUSOLINO
Suffix:
Gender:F
Credentials:PT, MSED, EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 WAKARA WAY
Mailing Address - Street 2:SUITE 302
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-1213
Mailing Address - Country:US
Mailing Address - Phone:801-259-7007
Mailing Address - Fax:
Practice Address - Street 1:829 E 400 S
Practice Address - Street 2:SUITE 102
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-2991
Practice Address - Country:US
Practice Address - Phone:801-581-8665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5135727-2401177F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes177F00000XOther Service ProvidersLodging