Provider Demographics
NPI:1790954071
Name:SMYTH-GARDNER, GINA LUCIA (PT)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:LUCIA
Last Name:SMYTH-GARDNER
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 1:2875 BARN RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-6361
Mailing Address - Country:US
Mailing Address - Phone:540-639-5786
Mailing Address - Fax:540-633-0708
Practice Address - Street 1:2875 BARN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-6361
Practice Address - Country:US
Practice Address - Phone:540-639-5786
Practice Address - Fax:540-633-0708
Is Sole Proprietor?:No
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305205108225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA496604Medicare Oscar/Certification