Provider Demographics
NPI:1154607703
Name:RICHARDSON, GINA L (DPT)
Entity type:Individual
Prefix:MISS
First Name:GINA
Middle Name:L
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1818 NEWKIRK AVE
Mailing Address - Street 2:LOBBY D
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-7359
Mailing Address - Country:US
Mailing Address - Phone:718-404-2539
Mailing Address - Fax:718-421-5391
Practice Address - Street 1:1818 NEWKIRK AVE
Practice Address - Street 2:LOBBY D
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-7359
Practice Address - Country:US
Practice Address - Phone:718-404-2539
Practice Address - Fax:718-421-5391
Is Sole Proprietor?:No
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034271225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6438229Medicare PIN