Provider Demographics
NPI:1962687442
Name:WILLIAMS, GINA M (DPT)
Entity Type:Individual
Prefix:MS
First Name:GINA
Middle Name:M
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:GINA
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:10545 AVENUE M
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-4603
Mailing Address - Country:US
Mailing Address - Phone:516-715-2601
Mailing Address - Fax:516-530-1960
Practice Address - Street 1:10545 AVENUE M
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-4603
Practice Address - Country:US
Practice Address - Phone:516-715-2601
Practice Address - Fax:516-530-1960
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-03
Last Update Date:2020-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10701225100000X
NY029964-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ4WFH1Medicare PIN