Provider Demographics
NPI:1386743136
Name:GIAMMANCO, GINA (PT)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:GIAMMANCO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:
Other - Last Name:EDMONDSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1500 16TH ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-5112
Mailing Address - Country:US
Mailing Address - Phone:415-788-2100
Mailing Address - Fax:415-788-2102
Practice Address - Street 1:1500 16TH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-5112
Practice Address - Country:US
Practice Address - Phone:415-788-2100
Practice Address - Fax:415-788-2102
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22547225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ26424ZMedicare UPIN