Provider Demographics
NPI:1336395789
Name:CHUBB, GINA RENEE (LMT)
Entity Type:Individual
Prefix:MS
First Name:GINA
Middle Name:RENEE
Last Name:CHUBB
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1871 NE 154TH AVE
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:FL
Mailing Address - Zip Code:32696-8648
Mailing Address - Country:US
Mailing Address - Phone:352-213-6070
Mailing Address - Fax:
Practice Address - Street 1:1871 NE 154TH AVE
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:FL
Practice Address - Zip Code:32696-8648
Practice Address - Country:US
Practice Address - Phone:352-213-6070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-15
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA53056225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist