Provider Demographics
NPI:1720376502
Name:LAYAGUE, GINA (PT)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:LAYAGUE
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 FLORIDA PARK DR N STE C
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-3891
Mailing Address - Country:US
Mailing Address - Phone:386-447-7824
Mailing Address - Fax:386-447-7864
Practice Address - Street 1:6 FLORIDA PARK DR N STE C
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-3891
Practice Address - Country:US
Practice Address - Phone:386-447-7824
Practice Address - Fax:386-447-7864
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-14
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL26613225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist