Provider Demographics
NPI:1689870552
Name:ELKIN, GINGER DALE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:GINGER
Middle Name:DALE
Last Name:ELKIN
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 1:316 BULLARD RD
Mailing Address - Street 2:
Mailing Address - City:ADEL
Mailing Address - State:GA
Mailing Address - Zip Code:31620-6359
Mailing Address - Country:US
Mailing Address - Phone:229-896-7040
Mailing Address - Fax:
Practice Address - Street 1:2700 N OAK ST
Practice Address - Street 2:SUITE A
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1772
Practice Address - Country:US
Practice Address - Phone:229-249-9600
Practice Address - Fax:229-249-9976
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA001585225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant