Provider Demographics
NPI:1790932143
Name:BARNES, GINA GAIL (PTA)
Entity Type:Individual
Prefix:MS
First Name:GINA
Middle Name:GAIL
Last Name:BARNES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:GINA
Other - Middle Name:GAIL
Other - Last Name:HERNDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:897 EVERGREEN ST
Mailing Address - Street 2:
Mailing Address - City:DRESDEN
Mailing Address - State:TN
Mailing Address - Zip Code:38225-2305
Mailing Address - Country:US
Mailing Address - Phone:731-364-2450
Mailing Address - Fax:731-364-9699
Practice Address - Street 1:897 EVERGREEN ST
Practice Address - Street 2:
Practice Address - City:DRESDEN
Practice Address - State:TN
Practice Address - Zip Code:38225-2305
Practice Address - Country:US
Practice Address - Phone:731-364-2450
Practice Address - Fax:731-364-9699
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000002549225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant