Provider Demographics
NPI:1982854675
Name:ROSS, GINA LYNN (PTA)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:LYNN
Last Name:ROSS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27702 CROWN VALLEY PARKWAY
Mailing Address - Street 2:D-4 #442
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694
Mailing Address - Country:US
Mailing Address - Phone:949-374-2395
Mailing Address - Fax:949-481-8682
Practice Address - Street 1:27702 CROWN VALLEY PKWY
Practice Address - Street 2:D-4 #442
Practice Address - City:LADERA RANCH
Practice Address - State:CA
Practice Address - Zip Code:92694-0608
Practice Address - Country:US
Practice Address - Phone:949-374-2395
Practice Address - Fax:949-481-8682
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT6114225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant