Provider Demographics
NPI:1205983442
Name:CALIFANO, GINA T (PT)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:T
Last Name:CALIFANO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7310 RITCHIE HWY
Mailing Address - Street 2:SUITE 500
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-3065
Mailing Address - Country:US
Mailing Address - Phone:410-766-4047
Mailing Address - Fax:410-766-4049
Practice Address - Street 1:7310 RITCHIE HWY
Practice Address - Street 2:SUITE 500
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3065
Practice Address - Country:US
Practice Address - Phone:410-766-4047
Practice Address - Fax:410-766-4049
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22067225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD283MQ207OtherPTAN, MEDICARE
MD283MQ207OtherPTAN, MEDICARE