Provider Demographics
NPI:1831130301
Name:SANDOVAL, GINA (DPT)
Entity Type:Individual
Prefix:MS
First Name:GINA
Middle Name:
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:GINA
Other - Middle Name:
Other - Last Name:SANDOVAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 33286
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87594-3286
Mailing Address - Country:US
Mailing Address - Phone:505-424-1239
Mailing Address - Fax:888-746-4761
Practice Address - Street 1:2538 CAMINO ENTRADA
Practice Address - Street 2:STE. 300
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-4919
Practice Address - Country:US
Practice Address - Phone:505-424-1239
Practice Address - Fax:888-746-4761
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM15232251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic