Provider Demographics
NPI:1912989294
Name:SMITH, GINA MARIE (PT)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:SMITH
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 1:7230 S LAND PARK DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-3657
Mailing Address - Country:US
Mailing Address - Phone:916-393-0497
Mailing Address - Fax:916-393-5567
Practice Address - Street 1:7230 S LAND PARK DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-3659
Practice Address - Country:US
Practice Address - Phone:916-393-0497
Practice Address - Fax:916-393-5567
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17844225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist