Provider Demographics
NPI:1821079443
Name:AZAR, GINA (PT)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:AZAR
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 1:220 RESERVOIR ST 32
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-3133
Mailing Address - Country:US
Mailing Address - Phone:781-400-1236
Mailing Address - Fax:781-400-1247
Practice Address - Street 1:220 RESERVOIR ST 32
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-3133
Practice Address - Country:US
Practice Address - Phone:781-400-1236
Practice Address - Fax:781-400-1247
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-10
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16038225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y69515Medicare ID - Type Unspecified