Provider Demographics
NPI:1861756405
Name:DANIS, GINA R (LMT)
Entity type:Individual
Prefix:MS
First Name:GINA
Middle Name:R
Last Name:DANIS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 COMLY RD APT 10
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19154-3316
Mailing Address - Country:US
Mailing Address - Phone:215-355-4212
Mailing Address - Fax:
Practice Address - Street 1:660 SECOND STREET PIKE STE 201
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-3995
Practice Address - Country:US
Practice Address - Phone:215-355-4212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-28
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG003466172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist