Provider Demographics
NPI:1831160852
Name:GAUSTAD, GINA J (PT)
Entity type:Individual
Prefix:MS
First Name:GINA
Middle Name:J
Last Name:GAUSTAD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USAHC CMR 457
Mailing Address - Street 2:P.O.BOX 334
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09033
Mailing Address - Country:US
Mailing Address - Phone:01511-001-0462
Mailing Address - Fax:
Practice Address - Street 1:USAHC
Practice Address - Street 2:CMR 457 BOX 334
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09033
Practice Address - Country:US
Practice Address - Phone:01511-001-0462
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-28
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2619225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist