Provider Demographics
NPI:1760855977
Name:NERI, GINA (PTA)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:NERI
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 1:5595 COURTNEYS CORNER RD
Mailing Address - Street 2:
Mailing Address - City:SUMERDUCK
Mailing Address - State:VA
Mailing Address - Zip Code:22742-1806
Mailing Address - Country:US
Mailing Address - Phone:540-272-0993
Mailing Address - Fax:
Practice Address - Street 1:1670 WEST LINGLEY RD
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401
Practice Address - Country:US
Practice Address - Phone:125-496-8215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-10
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306603394225200000X
TX2115647225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant