Provider Demographics
NPI:1649685553
Name:GIAMMANCO, GINA (MS, ATC, LAT)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:GIAMMANCO
Suffix:
Gender:F
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19079
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76019-0001
Mailing Address - Country:US
Mailing Address - Phone:817-272-0986
Mailing Address - Fax:817-272-7388
Practice Address - Street 1:601 PECAN DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76019-0001
Practice Address - Country:US
Practice Address - Phone:817-272-0986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT33302255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer