Provider Demographics
NPI:1023298437
Name:GINA'S PHYSICAL THERAPY, INC
Entity type:Organization
Organization Name:GINA'S PHYSICAL THERAPY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:RICCI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:772-223-3440
Mailing Address - Street 1:4287 SE FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-4936
Mailing Address - Country:US
Mailing Address - Phone:772-223-3440
Mailing Address - Fax:772-221-3373
Practice Address - Street 1:4287 SE FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-4936
Practice Address - Country:US
Practice Address - Phone:772-223-3440
Practice Address - Fax:772-221-3373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT12992225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4554Medicare PIN