Provider Demographics
NPI:1700665809
Name:FAIOLA, GINA (PTA)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:FAIOLA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1770 PACIFIC AVE APT 17B
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-2410
Mailing Address - Country:US
Mailing Address - Phone:415-678-9727
Mailing Address - Fax:
Practice Address - Street 1:1359 PINE ST # 17B
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-4807
Practice Address - Country:US
Practice Address - Phone:415-673-8405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52595225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant