Provider Demographics
NPI:1104423276
Name:BERNAL, GINA VALENTI (DPT, ATC)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:VALENTI
Last Name:BERNAL
Suffix:
Gender:F
Credentials:DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 260
Mailing Address - Street 2:
Mailing Address - City:LANGLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98260
Mailing Address - Country:US
Mailing Address - Phone:360-321-4434
Mailing Address - Fax:360-321-4432
Practice Address - Street 1:432 THIRD ST
Practice Address - Street 2:
Practice Address - City:LANGLEY
Practice Address - State:WA
Practice Address - Zip Code:98260
Practice Address - Country:US
Practice Address - Phone:360-321-4434
Practice Address - Fax:360-321-4432
Is Sole Proprietor?:No
Enumeration Date:2020-10-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60888381225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist