Provider Demographics
NPI:1710102108
Name:STOFFER, GINA SUE (PT)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:SUE
Last Name:STOFFER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 STONEGATE DR.
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-9332
Mailing Address - Country:US
Mailing Address - Phone:304-905-0929
Mailing Address - Fax:304-905-0929
Practice Address - Street 1:6 STONEGATE DR.
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-9332
Practice Address - Country:US
Practice Address - Phone:304-905-0929
Practice Address - Fax:304-905-0929
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV910225100000X
OH005285225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist