Provider Demographics
NPI:1700990694
Name:MACDONALD, GINA YVETTE (DR PHYSICAL THERAPY)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:YVETTE
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:DR PHYSICAL THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6301 FARINELLA DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-4221
Mailing Address - Country:US
Mailing Address - Phone:714-840-5671
Mailing Address - Fax:562-493-5148
Practice Address - Street 1:550 PACIFIC COAST HWY
Practice Address - Street 2:SUITE 203
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-5999
Practice Address - Country:US
Practice Address - Phone:562-493-5095
Practice Address - Fax:562-493-5148
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT24673174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist