Provider Demographics
NPI:1851648901
Name:PIERCE, GINA (LPTA)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:PIERCE
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:BARABOO
Mailing Address - State:WI
Mailing Address - Zip Code:53913-1503
Mailing Address - Country:US
Mailing Address - Phone:608-356-8532
Mailing Address - Fax:608-355-3333
Practice Address - Street 1:1414 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913-1503
Practice Address - Country:US
Practice Address - Phone:608-356-8532
Practice Address - Fax:608-355-3333
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI744-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant