Provider Demographics
NPI:1336352863
Name:CALDERONE, GINA MARIE (MPT)
Entity Type:Individual
Prefix:MS
First Name:GINA
Middle Name:MARIE
Last Name:CALDERONE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:MARIE
Other - Last Name:BETANCOURT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:273 XIMENO AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-1657
Mailing Address - Country:US
Mailing Address - Phone:562-882-0564
Mailing Address - Fax:562-438-8470
Practice Address - Street 1:4918 E 2ND ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-5318
Practice Address - Country:US
Practice Address - Phone:562-438-1176
Practice Address - Fax:562-438-8470
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27424225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist