Provider Demographics
NPI:1740602903
Name:BERRETTONI, GINA (PTA)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:BERRETTONI
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 1:800 HARRISON AVE
Mailing Address - Street 2:BOX 419
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2905
Mailing Address - Country:US
Mailing Address - Phone:617-636-5632
Mailing Address - Fax:
Practice Address - Street 1:800 HARRISON AVE
Practice Address - Street 2:BOX 419
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2905
Practice Address - Country:US
Practice Address - Phone:617-636-5632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8621225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant