MEDICARE: KARA GINGO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	012652	OH

General Provider Information

NPI Number	:	1497219976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARA GINGO

Provider Business Mailing Address
First Line	:	1300 FIRESIDE TRL
Second Line	:
City	:	BROADVIEW HTS
State	:	OH
Zip	:	44147-3678
Country	:	US
Telephone Number	:	330-414-8468
Fax Number	:

Provider Business Practice Location Address
First Line	:	9500 BROADVIEW RD
Second Line	:
City	:	BROADVIEW HTS
State	:	OH
Zip	:	44147-2302
Country	:	US
Telephone Number	:	330-414-8468
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2019
Last Update Date	:	01/29/2019

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Directions to “ KARA GINGO ” Practice Location

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