Provider Demographics
NPI:1356571210
Name:GERONA, GINA (LPTA,ATC,LMT)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:GERONA
Suffix:
Gender:F
Credentials:LPTA,ATC,LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2802 PARENTAL HOME RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-5702
Mailing Address - Country:US
Mailing Address - Phone:352-721-0088
Mailing Address - Fax:
Practice Address - Street 1:2802 PARENTAL HOME RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-5702
Practice Address - Country:US
Practice Address - Phone:352-721-0088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-24
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA17603225200000X
FLAL21682255A2300X
FLMA55451225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist