Provider Demographics
NPI:1770730004
Name:ROCKWELL, GINA MARIE (PTA)
Entity type:Individual
Prefix:MS
First Name:GINA
Middle Name:MARIE
Last Name:ROCKWELL
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 1:158 ROSEMARY ST
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-8230
Mailing Address - Country:US
Mailing Address - Phone:360-427-0243
Mailing Address - Fax:
Practice Address - Street 1:153 JOHNS CT
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-8225
Practice Address - Country:US
Practice Address - Phone:360-427-2575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant