Provider Demographics
NPI:1679974745
Name:CHERICO, GINA MARIE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:CHERICO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 BLUEWATER BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-3888
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-362-8684
Practice Address - Street 1:119 CANAL ST STE 104
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-4094
Practice Address - Country:US
Practice Address - Phone:912-330-8444
Practice Address - Fax:912-332-8844
Is Sole Proprietor?:No
Enumeration Date:2014-09-09
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15181225100000X
FLPT36278225100000X
GAPT013235225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist