Provider Demographics
NPI:1912065533
Name:SICONOLFI, GINA CECILIA (PT, PHD)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:CECILIA
Last Name:SICONOLFI
Suffix:
Gender:F
Credentials:PT, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 MICHAELS LN
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19086-6630
Mailing Address - Country:US
Mailing Address - Phone:856-347-0677
Mailing Address - Fax:
Practice Address - Street 1:115 PHEASANT RUN STE 215
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-1886
Practice Address - Country:US
Practice Address - Phone:215-550-6109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0002975225100000X
PAPT032148225100000X
NY025377-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist