Provider Demographics
NPI:1093506495
Name:ST. LOUIS, GIANNA SOPHIA
Entity type:Individual
Prefix:
First Name:GIANNA
Middle Name:SOPHIA
Last Name:ST. LOUIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 RED TAIL HAWK CT
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:08801-4018
Mailing Address - Country:US
Mailing Address - Phone:908-872-8963
Mailing Address - Fax:
Practice Address - Street 1:21 RED TAIL HAWK CT
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:NJ
Practice Address - Zip Code:08801-4018
Practice Address - Country:US
Practice Address - Phone:908-872-8963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJS827328282590322255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer