Provider Demographics
NPI:1265093280
Name:GIORGI, EMILY MARIA (LAT, ATC)
Entity type:Individual
Prefix:MISS
First Name:EMILY
Middle Name:MARIA
Last Name:GIORGI
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4545 PIMLICO DR UNIT 201
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-2091
Mailing Address - Country:US
Mailing Address - Phone:916-822-1338
Mailing Address - Fax:
Practice Address - Street 1:2101 E COLISEUM BLVD STE 100
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-1499
Practice Address - Country:US
Practice Address - Phone:260-481-6656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-21
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36003054A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer