Provider Demographics
NPI:1801176896
Name:GIGINYAK, ALEXANDER (PTA)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:GIGINYAK
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1061 BEACH PARK BLVD
Mailing Address - Street 2:APT 305
Mailing Address - City:FOSTER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94404-3459
Mailing Address - Country:US
Mailing Address - Phone:408-712-6171
Mailing Address - Fax:
Practice Address - Street 1:171 SCHOOL ST STE A
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94014-2433
Practice Address - Country:US
Practice Address - Phone:650-756-3740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8798225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant