Provider Demographics
NPI:1831680164
Name:MALITO, GINA ELIZABETH (DPT)
Entity Type:Individual
Prefix:MS
First Name:GINA
Middle Name:ELIZABETH
Last Name:MALITO
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Gender:F
Credentials:DPT
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Mailing Address - Street 1:4444 FOREST PARK AVE
Mailing Address - Street 2:C B 8502
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-2212
Mailing Address - Country:US
Mailing Address - Phone:314-286-1940
Mailing Address - Fax:314-286-1473
Practice Address - Street 1:4444 FOREST PARK AVE
Practice Address - Street 2:STE 1212
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2212
Practice Address - Country:US
Practice Address - Phone:314-286-1940
Practice Address - Fax:314-286-1473
Is Sole Proprietor?:No
Enumeration Date:2018-05-22
Last Update Date:2018-08-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2018020947225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist