Provider Demographics
NPI:1578715249
Name:GINES, CARINA GUDRUN (PTA)
Entity Type:Individual
Prefix:
First Name:CARINA
Middle Name:GUDRUN
Last Name:GINES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 FERNSTONE CT
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-8040
Mailing Address - Country:US
Mailing Address - Phone:813-643-6940
Mailing Address - Fax:
Practice Address - Street 1:4701 FERNSTONE CT
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-8040
Practice Address - Country:US
Practice Address - Phone:813-643-6940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 21231225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant