Provider Demographics
NPI:1821223330
Name:TAPIAS, GINA PAOLA (PTA)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:PAOLA
Last Name:TAPIAS
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 1:3474 SW MARTIN ST
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-4909
Mailing Address - Country:US
Mailing Address - Phone:772-785-9866
Mailing Address - Fax:
Practice Address - Street 1:527 NW CASHMERE BLVD
Practice Address - Street 2:UNIT 103 THE PALMS @ ST LUCIE WEST
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34968
Practice Address - Country:US
Practice Address - Phone:772-204-9822
Practice Address - Fax:772-336-9932
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA20845225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant